Treatment of Multicentric Reticulohistiocytosis With Tocilizumab

Abstract

Multicentric reticulohistiocytosis (MRH) is a rare multisystem, granulomatous debilitating disease. It affects the skin with a nodular diffuse dermatitis and the joints with a severe, potentially deforming, and handicapping arthritis. No standardized therapy exists, it is a disease with heterogeneous severity, and therefore, a diversity of therapeutic responses has been published.Current experience with anti-tumor necrosis factor agents in disease-modifying antirheumatic drug-refractory MRH cases is encouraging, and other agents such as bisphosphonates have proven effective as well. Histological analysis of the granulomatous inflammatory lesions have shown the presence of cytokines including tumor necrosis factor α, interleukin 1, and interleukin 6; the presence of the latter makes tocilizumab a plausible alternative.In this article, we report a 35-year-old woman with MRH refractory to a combined scheme of prednisone and methotrexate, both at high doses, and who received tocilizumab achieving remission on both cutaneous and articular symptoms. Our patient markedly improved by the second infusion (8 mg/kg monthly), and after 9 infusions, she remained asymptomatic; no toxicity was detected. Tocilizumab could be an alternative for disease-modifying antirheumatic drug-refractory MRH.

The Non-Langerhans Cell Histiocytoses (Rare Histiocytoses) – Clinical Aspects and Therapeutic Approaches

“…Therapy: Therapy of choice is surgical resection, but cosmetic aspects have to be considered [23]. In cases with severe systemic involvement, steroids or cytostatic drugs were not effective, whereas some success was described for the application of TNFalpha blockade by antibodies [154,209,229]. For bone and joint involvement, bisphosphonates seem to be useful [209].…”

Looks Can Be Deceiving: A Case Report on Multicentric Reticulohistiocytosis Successfully Treated with Rituximab

“…Etanercept, adalimumab, and infliximab have been reported to be effective in some case reports although our patient did not respond well to these agents. Recent case reports also showed satisfactory treatment response with anakinra and tocilizumab [6]. Bisphosphonates can also be added in patients with poor disease control or evidence of osteoporosis or osteopenia.…”

Multicentric Reticulohistiocytosis: A Reason for Erosive Arthritis

“…Unfortunately, remission has been achieved only rarely [13,18]. Recently, cyclosporine, anti-TNF-α agents, tocilizumab, leflunomide and alendronate have been tried and appear to offer other effective therapeutic options [22][23][24][25][26]. Prior to initiating aggressive therapy, screening of malignancy and TB should be performed.…”