Abstract
The treatment of patients with active RA (rheumatoid arthritis) and respiratory complications, such as obsolete tuberculosis and lung fibrosis,is an important clinical issue for rheumatologists. In most cases, classic DMARDs (disease-modifying antirheumatic drugs) were used and ineffective already. Methotrexate and leflunomide are not suitable because of preexisting respiratory complications. It is risky to use TNF (tumor necrosis factor) inhibitors because they increase the risk of tuberculosis and other infectious diseases.
Monotherapy with tocilizumab, which is an IL-6 (interleukin-6) inhibitor, was superior to monotherapy with methotrexate or TNF inhibitors. Tocilizumab was generally well tolerated in patients with active RA. The incidence of serious infections was also generally low, no greater than the incidence observed with MTX or TNF inhibitors. Tocilizumab does not increase the risk of tuberculosis. Therefore, tocilizumab was adopted to treat two high-risk patients, a 63-yearold woman with obsolete pulmonary tuberculosis and chronic bronchitis and an 82-year-old woman with lung fibrosis. DAS28ESR was 5.02 and 6.04, respectively. Tocilizumab was carefully administrated under following conditions: (ⅰ) adequate treatment and/or control of any comorbidity (e.g., infectious diseases, lifestyle diseases, etc.) before and during administration of tocilizumab, (ⅱ) appropriate infection control precautions and health care, and (ⅲ) prompt response to adverse events. After treatment with tocilizumab, RA rapidly remitted and QOL improved. Though tocilizumab therapy is not to be recommended positively for high-risk patients, tocilizumab can be a therapeutic option.
