Successful tocilizumab and tacrolimus treatment in a patient with rheumatoid arthritis complicated by systemic lupus erythematosus

Abstract

We report a 37-year-old female of intractable rheumatoid arthritis (RA) complicated by systemic lupus erythematosus (SLE), who was successfully treated with a combination of tocilizumab (TCZ) and tacrolimus. She was diagnosed with RA when she was 21 years old, and was administered oral prednisolone, injectable gold and salazosulfapyridine, but deformity of her hands gradually developed. She developed high fever and thrombocytopenia when she was 35 years old. Renal involvement, pericarditis, positive antinuclear antibody and high level of anti-double-stranded DNA antibody were found and the patient was diagnosed with SLE. Polyarthritis and immunological abnormalities developed despite aggressive immunosuppressive therapy including high-dose corticosteroids and intravenously administered cyclophosphamide. Tacrolimus (TAC) therapy gave only partial improvement of joint symptoms. After the initiation of combination therapy with TCZ, not only was a complete remission of RA obtained, but also the serum levels of SLE markers dramatically decreased. Our report suggests the possibility that this combination therapy is effective in treating SLE as well as RA.

Off-label use of tocilizumab to treat non-juvenile idiopathic arthritis in pediatric rheumatic patients: a literature review

“…In an open-label phase I study, tocilizumab improved the disease scores of patients with moderately active SLE, but neutropenia and infection developed in a dose-dependent manner [20]. Nonetheless, several case reports have described the successful use of tocilizumab in the treatment of SLE flares in adult patients [21–23]. Combined cyclophosphamide and tocilizumab treatment improved massive pericarditis and glomerulonephritis in a patient with refractory SLE [24].…”

Tocilizumab in the treatment of mixed connective tissue disease and overlap syndrome in children

“…In contrast, TCZ has been reported with contradictory results in adult-onset SLE with single case reports displaying either improvement or flare under treatment. 9 10 Interestingly, arthritis seems highly sensitive to IL-6 blockers in this context while systemic symptoms seem less sensitive to TCZ. In a small open study of TCZ in adult-onset SLE, patients presented with leucopenia and a decrease of complement fraction.…”

Tocilizumab-induced remission of nephrotic syndrome accompanied by secondary amyloidosis and glomerulonephritis in a patient with rheumatoid arthritis

“…In this regard, tocilizumab could have ameliorated the lupus nephritis in the present case. IL-6 plays critical roles in the pathogenesis of SLE [21]. However, because the patient had been suffering from chronic liver dysfunction, and showed incompatible findings (negativity for anti-nuclear antibodies, absence of wire-loop lesions and electron dense deposit by histology, absence of other SLE-related clinical symptoms, relatively low coincidence of lupus nephritis and AA amyloidosis) [22], we believe that even if SLE was present, the glomerulonephritis and renal amyloidosis were related to RA, although we could not completely rule out the possibility of the coincidental development of SLE.…”