A7-year-old　boy　with　oligoarticular　JIA　achieving　the　structural　remission　by　tocilizumab　treatment

Abstract

A seven-year-old　boy　had　had　his　right　ankle　sprained，　while　practicing　a　Japanese　martial　art，kendo．　A PTB　brace　had　been　installed　on　the　right　fbot，but　the　symptom　had　worsened．Six　months　after　the　onset，　he　was　diagnosed　with　oligoarticular　juvenile　idiopathic　arthritis．　The　MRI was　revealed　a　hyperplasia　of　synovium　and　a　destruction　of　cartilage　on　his　ankle．　Also，　the　level　of　serum MMP-3　was　high．Nine　months　after　the　onset，a　low-dose　methotrexate　pulse　therapy　was　initiated，　but　he　was　not　able　to walk　without　a　crutch．　The　narrowing　of　the　joint　space　progressively　revealed　by　ankle　x-ray　image．　The　levels of MMP-3　and　anti-CCP-antibody　continued　high．Nineteen　months　after　the　onset，　he　started　tocilizumab　therapy．　Then，　the　levels　of CRP，　ESR，　and　MMP- 3 were reduced to normal，　and　the　narrowing　of　the　joint　space　remarkably　improved．In　conclusion，the　tocilizumab　therapy　could　be　inhibited　a　destruction　of　bones　and　cartilages　of oligoarticular　JIA，and　improved　the　radiological　findings　of　articular　damages　of oligoarticular JIA．