Reactions 1680, p323 - 2 Dec 2017 Nodular scleritis: case report A 48-year-old woman developed anterior nodular scleritis following initiation of tocilizumab therapy for rheumatoid arthritis (RA). The woman had a history of RA, pyoderma gangrenosum, and systemic lupus erythematosus. Although, she had been treated with rituximab, methotrexate, sulfasalazine, hydroxychloroquine, and folic acid, her RA remained in active state. Therefore, her treatment was changed to IV tocilizumab 8 mg/kg every four weeks. Rituximab and methotrexate were discontinued prior to initiating tocilizumab. After the first dose of tocilizumab, clinical remission of her RA was noted, with a 28 joint Disease Activity Score of 2.41 as compared to previous score of 6.28. Additionally, the CRP decreased to < 1 from 28. Emergence of a lesion in an eye was noted subsequent to the second dose of tocilizumab. The lesion was diagnosed as nodular scleritis and the woman was treated with tapering dose of prednisone with clinical response. Tocilizumab was discontinued simultaneously and complete resolution of the nodular lesion was noted at nine months, without steroids. No other signs of intraocular inflammation were noted on ophthalmological examination using the slit-lamp. A tuberculosis blood test, full blood count and Treponema screen were performed to exclude infectious aetiology. It was postulated that this was a paradoxical effect of the tocilizumab treatment, provided that she had no previous incident of extra-articular manifestations, her inflammatory profile was suppressed, and considering the temporal relationship with initiation of tocilizumab. The woman did not accept the offer for tocilizumab re- challenge. Author comment: "[Tocilizumab] is an anti–IL-6 receptor monoclonal antibody, thereby conferring its antiinflammatory properties through this mechanism." "We conclude that ocular manifestations as a result of IL-6 inhibition should be considered as a possible paradoxical phenomenon when treating inflammatory arthritis." Michael E, et al. Paradoxical nodular scleritis during tocilizumab therapy: A case report. The Journal of Rheumatology 44: 1760-1761, No. 11, 01 Nov 2017. Available from: URL: http://doi.org/10.3899/jrheum.170234 - New Zealand 803285040 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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