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Dramatic radiographic repair by tocilizumab in a very elderly patient with rheumatoid arthritis.

Watanabe R, Hirabayashi Y, Okuno H, Ishii T, Harigae H - Mod Rheumatol (2013)

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine , Sendai , Japan.

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Here we present the case of a very elderly patient with RA who showed dramatic radiographic repair by TCZ... The scale of erosions had decreased and a smooth cortex had been generated on the surface of the erosions... The van der Heijde-modified total Sharp score (mTSS), which was scored by two trained readers in a blinded manner, also improved year by year (Figure 1i)... Radiographic repair does occur, but it is observed almost exclusively in joints with no signs of swelling. van der Linden et al. reported that radiographic repair was observed in 18 out of 250 patients (7.2%), and patients who showed radiographic repair had a high prevalence of autoantibodies such as rheumatoid factor and anti-CCP antibody... In the cases of seropositive patients, more radiographic damage and functional decline have been observed in EORA patients than in YORA patients... In EORA patients, age-associated factors, such as comorbidities and decreased drug metabolism capacity, often limit the treatment options and worsen their prognosis... We previously reported that no significant difference in efficacy or safety profile of TCZ was found between the groups of elderly (over 65 years old) and nonelderly (below 65 years old) patients and that SJC < 1 was achieved by 67% of patients after 6 months of TCZ use... TCZ enables both rapid reduction of joint swelling and long-term complete remission irrespective of age, leading to repair of bone erosions... In fact, this case indicates that bone repair can occur even in a very elderly patient with RA during long-term complete remission with TCZ.

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Metacarpophalangeal (MCP) joint of left index finger at first visit (a) and after 1 year (b), 2 years (c) and 3 years (d). The swelling of the joint disappeared by 3 weeks after administration of TCZ. MCP joint of right index finger at first visit (e) and after 1 year (f), 2 years (g) and 3 years (h). The swelling of the joint disappeared by 8 weeks after administration of TCZ. (i) Clinical course of the patient. JSN: Joint Space Narrowing, mTSS; modified Total Sharp Score.
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Figure 1: Metacarpophalangeal (MCP) joint of left index finger at first visit (a) and after 1 year (b), 2 years (c) and 3 years (d). The swelling of the joint disappeared by 3 weeks after administration of TCZ. MCP joint of right index finger at first visit (e) and after 1 year (f), 2 years (g) and 3 years (h). The swelling of the joint disappeared by 8 weeks after administration of TCZ. (i) Clinical course of the patient. JSN: Joint Space Narrowing, mTSS; modified Total Sharp Score.

Mentions: An 80-year-old woman was referred to Hikarigaoka Spellman Hospital for treatment of active RA. She had been diagnosed with RA 4 years earlier (rheumatoid factor, 182 IU/ml) and had been treated with methotrexate (6 mg/week) and salazosulfapyridine. The patient had a swollen joint count (SJC) of 6 and tender joint count (TJC) of 6. The patient global assessment using a visual analogue scale was 79 mm. Erythrocyte sedimentation rate (ESR) was 29 mm/h and anti-cyclic citrullinated peptide (CCP) antibody was above 100 U/ml. The 28-joint disease activity score using ESR (DAS28-ESR) was 5.52. Steinbrocker functional class was II and stage was IV. After administration of TCZ (8 mg/kg every 4 weeks) as monotherapy, she achieved DAS28-ESR remission by 16 weeks and Boolean remission by 34 weeks. Since then, she has been in remission for 3 years with no serious adverse events except for one incidence of acute pneumonia caused by Chlamydia pneumoniae. Follow-up X-rays for 3 years showed dramatic repair of bone erosion (Figure 1a–h). The scale of erosions had decreased and a smooth cortex had been generated on the surface of the erosions. The van der Heijde-modified total Sharp score (mTSS), which was scored by two trained readers in a blinded manner, also improved year by year (Figure 1i).


Dramatic radiographic repair by tocilizumab in a very elderly patient with rheumatoid arthritis.

Watanabe R, Hirabayashi Y, Okuno H, Ishii T, Harigae H - Mod Rheumatol (2013)

Metacarpophalangeal (MCP) joint of left index finger at first visit (a) and after 1 year (b), 2 years (c) and 3 years (d). The swelling of the joint disappeared by 3 weeks after administration of TCZ. MCP joint of right index finger at first visit (e) and after 1 year (f), 2 years (g) and 3 years (h). The swelling of the joint disappeared by 8 weeks after administration of TCZ. (i) Clinical course of the patient. JSN: Joint Space Narrowing, mTSS; modified Total Sharp Score.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4221015&req=5

Figure 1: Metacarpophalangeal (MCP) joint of left index finger at first visit (a) and after 1 year (b), 2 years (c) and 3 years (d). The swelling of the joint disappeared by 3 weeks after administration of TCZ. MCP joint of right index finger at first visit (e) and after 1 year (f), 2 years (g) and 3 years (h). The swelling of the joint disappeared by 8 weeks after administration of TCZ. (i) Clinical course of the patient. JSN: Joint Space Narrowing, mTSS; modified Total Sharp Score.
Mentions: An 80-year-old woman was referred to Hikarigaoka Spellman Hospital for treatment of active RA. She had been diagnosed with RA 4 years earlier (rheumatoid factor, 182 IU/ml) and had been treated with methotrexate (6 mg/week) and salazosulfapyridine. The patient had a swollen joint count (SJC) of 6 and tender joint count (TJC) of 6. The patient global assessment using a visual analogue scale was 79 mm. Erythrocyte sedimentation rate (ESR) was 29 mm/h and anti-cyclic citrullinated peptide (CCP) antibody was above 100 U/ml. The 28-joint disease activity score using ESR (DAS28-ESR) was 5.52. Steinbrocker functional class was II and stage was IV. After administration of TCZ (8 mg/kg every 4 weeks) as monotherapy, she achieved DAS28-ESR remission by 16 weeks and Boolean remission by 34 weeks. Since then, she has been in remission for 3 years with no serious adverse events except for one incidence of acute pneumonia caused by Chlamydia pneumoniae. Follow-up X-rays for 3 years showed dramatic repair of bone erosion (Figure 1a–h). The scale of erosions had decreased and a smooth cortex had been generated on the surface of the erosions. The van der Heijde-modified total Sharp score (mTSS), which was scored by two trained readers in a blinded manner, also improved year by year (Figure 1i).

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine , Sendai , Japan.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Here we present the case of a very elderly patient with RA who showed dramatic radiographic repair by TCZ... The scale of erosions had decreased and a smooth cortex had been generated on the surface of the erosions... The van der Heijde-modified total Sharp score (mTSS), which was scored by two trained readers in a blinded manner, also improved year by year (Figure 1i)... Radiographic repair does occur, but it is observed almost exclusively in joints with no signs of swelling. van der Linden et al. reported that radiographic repair was observed in 18 out of 250 patients (7.2%), and patients who showed radiographic repair had a high prevalence of autoantibodies such as rheumatoid factor and anti-CCP antibody... In the cases of seropositive patients, more radiographic damage and functional decline have been observed in EORA patients than in YORA patients... In EORA patients, age-associated factors, such as comorbidities and decreased drug metabolism capacity, often limit the treatment options and worsen their prognosis... We previously reported that no significant difference in efficacy or safety profile of TCZ was found between the groups of elderly (over 65 years old) and nonelderly (below 65 years old) patients and that SJC < 1 was achieved by 67% of patients after 6 months of TCZ use... TCZ enables both rapid reduction of joint swelling and long-term complete remission irrespective of age, leading to repair of bone erosions... In fact, this case indicates that bone repair can occur even in a very elderly patient with RA during long-term complete remission with TCZ.

Show MeSH
Related in: MedlinePlus