Abstract
A 72-year-old woman was admitted to our hospital with complaints of general malaise, mild fever, and polyarthlargia in February 2010. She had been diagnosed as having rheumatoid arthritis in 1999, and in spite of the treatment with conventional DMARDs therapy followed by TNFαinhibitors of etenercept and adalimumab, her disease activity was not well controlled. Her Steinblocker Classification was Stage IV, and her Functional Class was Class 4.Investigations showed that her symptoms were derived from disease activity of her rheumatoid arthritis. We started 40 mg/day prednisolone, however opportunistic infection occurred, and anemia and hypoalbuminemia progressed. Her activities of daily living (ADL) worsened and a pressure ulcer appeared. Although she had some risk factors such as her age being over 65 years and being Functional Class 4, we administered Tocilizumab (TCZ) 8 mg/kg with cyclophosphamide 50 mg/day in order to control the disease activity. After the administration of TCZ, her disease activity was well controlled and anemia and hypoalubuminemia dramatically improved without any infections and adverse events. The pressure ulcer was cured and TCZ was stopped after the fourth administration.
This case suggests that TCZ can strongly suppress inflammation and improve anemia, hypoalbuminemia induced by the disease activity itself. The pressure ulcer was then cured, accompanied by improvement of ADL. Although TCZ carries an increased risk of infections, TCZ can be used carefully for the treatment of severe rheumatoid arthritis with some risk factors.
