J Rheum Dis.  2018 Apr;25(2):144-147. 10.4078/jrd.2018.25.2.144.

Patient with Systemic Lupus Erythematosus Combined with Erosive Arthritis was Treated Successfully with Tocilizumab: A Case Report

Affiliations
  • 1Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea. nakhada@naver.com
  • 2Department of Radiology, Ajou University School of Medicine, Suwon, Korea.

Abstract

Systemic lupus erythematosus (SLE) is a systemic autoimmune inflammatory disease that frequently involves the joints at some stage during the disease course. Although lupus arthritis is usually non-erosive, approximately 5% of patients develop erosions. This paper reports a patient with SLE combined with erosive arthritis, who was treated successfully with tocilizumab. A 20-year-old female, who was first diagnosed with SLE at the age of 13 years, had been admitted frequently to hospital with disease flare-ups during the previous 3 years. Despite aggressive treatment, her arthritis became aggravated, particularly in both wrists and the right knee. Radiologically, erosive arthritis was noted in the wrists.The serum interleukin (IL)-6 level was elevated significantly along with the other inflammatory markers. After the tocilizumab treatment, the arthritis subsided with a normalization of the IL-6 level, suggesting that tocilizumab may be a suitable treatment for lupus erosive arthritis if the IL-6 level is high.

Keyword

Systemic lupus erythematosus; Arthritis; Interleukin-6 inhibitor; Interleukin-6

MeSH Terms

Arthritis*
Female
Humans
Interleukin-6
Interleukins
Joints
Knee
Lupus Erythematosus, Systemic*
Wrist
Young Adult
Interleukin-6
Interleukins

Figure

  • Figure 1. (A) Axial T2-weighted fat-suppressed and T1-weighted images reveal osteonecrosis with the double-line sign, representing the outer rim of the sclerosis (arrow) and the inner rim of the high-signal intensity region in the distal femoral condyles. (B) Both anteroposterior and oblique images of the left hand reveal erosion with narrowing of the joint space, and ankylosis between the trapezoid, cap-itate, and hamate; and the second, third, and fourth meta-carpal bases.

  • Figure 2. The time courses of the levels of complement 4 (C4), interleukin-6 (IL-6), anti-double-stranded DNA (anti-dsDNA) antibodies, white blood cells (WBCs), and C-reactive protein (CRP).


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