Hepatotoxicity due to tocilizumab and anakinra in rheumatoid arthritis: two case reports

Elevation of liver enzymes in patients with rheumatoid arthritis treated with the biological agents, tocilizumab and anakinra, is now well documented. However, histological characterization of these effects and outcomes has not been defined. Here we report toxic liver effects in two women with rheumatoid arthritis, refractory to all nonbiological therapies, following treatment with anakinra and tocilizumab. Liver biopsy in both cases showed focal necrosis of hepatocytes as a hallmark of drug toxicity, along with steatosis and early fibrosis. In addition, the patient treated with anakinra demonstrated inflammatory changes. Tocilizumab was continued with no further deterioration in liver function. Withdrawal of anakinra led to rapid normalization of liver function. The biological agents, tocilizumab and anakinra, may result in significant histological hepatic changes, including necrosis, but despite this, the outcome appears to be good

Radiocarbon dating of human burials from Raqefet Cave and contemporaneous Natufian traditions at Mount Carmel

International audienceThe Natufian culture (c. 15–11.5 ka cal BP) marks a pivotal step in the transition from hunting and gathering to sedentism and farming in the Near East. Although conventionally divided into Early and Late phases, this internal chronology lacks support from reliable absolute dates. This is now addressed by new AMS dating from two neighbouring Natufian sites at Mount Carmel in Israel: Raqefet Cave, conventionally assigned to the Late phase of the Natufian; and el- Wad Terrace, spanning the entire Natufian sequence. Results indicate that these two sites were in fact contemporaneous at some point, but with distinct lunate assemblages. Distinguishing between Natufian phases is, therefore, more complex than previously thought; the social implications of diverse but co-existing cultural manifestations must be considered in any future reconstruction of the Natufian