トシリズマブの投与により褥創の改善が得られた難治性関節リウマチの一例
症例は72歳女性．1999年に関節リウマチを発症し高疾患活動性が持続した．2010年２月に全身倦怠感，微熱，多関節痛で入院した．ステロイドを増量したが，感染症を繰り返し，低蛋白血症が進行し，日常生活動作が困難となり臀部に褥創をきたした．計４回のトシリズマブの投与で全身状態は改善し，それに伴い褥創も改善した．疾患活動性により全身状態が悪化した症例ではトシリズマブの投与で有効性が得られると考えられた．...
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| Published in | 臨床リウマチ Vol. 25; no. 2; pp. 119 - 124 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本臨床リウマチ学会
2013
The Japanese Society for Clinical Rheumatology and Related Research |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-8760 2189-0595 |
| DOI | 10.14961/cra.25.119 |
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| Abstract | 症例は72歳女性．1999年に関節リウマチを発症し高疾患活動性が持続した．2010年２月に全身倦怠感，微熱，多関節痛で入院した．ステロイドを増量したが，感染症を繰り返し，低蛋白血症が進行し，日常生活動作が困難となり臀部に褥創をきたした．計４回のトシリズマブの投与で全身状態は改善し，それに伴い褥創も改善した．疾患活動性により全身状態が悪化した症例ではトシリズマブの投与で有効性が得られると考えられた． |
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| AbstractList | 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.
症例は72歳女性．1999年に関節リウマチを発症し高疾患活動性が持続した．2010年２月に全身倦怠感，微熱，多関節痛で入院した．ステロイドを増量したが，感染症を繰り返し，低蛋白血症が進行し，日常生活動作が困難となり臀部に褥創をきたした．計４回のトシリズマブの投与で全身状態は改善し，それに伴い褥創も改善した．疾患活動性により全身状態が悪化した症例ではトシリズマブの投与で有効性が得られると考えられた． 症例は72歳女性．1999年に関節リウマチを発症し高疾患活動性が持続した．2010年２月に全身倦怠感，微熱，多関節痛で入院した．ステロイドを増量したが，感染症を繰り返し，低蛋白血症が進行し，日常生活動作が困難となり臀部に褥創をきたした．計４回のトシリズマブの投与で全身状態は改善し，それに伴い褥創も改善した．疾患活動性により全身状態が悪化した症例ではトシリズマブの投与で有効性が得られると考えられた． |
| Author | 中川, 育磨 武井, 望 小谷, 俊雄 清水, 悠以 竹田, 剛 |
| Author_FL | Odani Toshio Nakagawa Ikuma Takeda Tsuyoshi Takei Nozomu Shimizu Yui |
| Author_FL_xml | – sequence: 1 fullname: Takei Nozomu – sequence: 2 fullname: Shimizu Yui – sequence: 3 fullname: Nakagawa Ikuma – sequence: 4 fullname: Odani Toshio – sequence: 5 fullname: Takeda Tsuyoshi |
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| DocumentTitleAlternate | Successful treatment of pressure ulcer with Tocilizumab in a case of severe rheumatoid arthritis |
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| References | 5) Lin, Z.Q., Kondo, T., Ishida, Y. et al.: Essential involvement of IL-6 in the skin wound-healing process as evidenced by delayed wound healing in Il-6-dificient mice. J. Leukoc. Biol., 73: 713-721, 2003. 6) Nishimoto, N.: Inerleukin-6 in rheumatoid arthtitis. Curr. Opin. Rheumatol., 18: 277-281, 2006. 7) Nishimoto, N., Ito K., Takagi, N.: Safety and efficacy profiles of tocilizumab monotherapy in Japanese patients with rheumatoid arthritis: meta-analysis of six initial trials and five long-term extensions. Mod. Rheumatol., 20: 222-232, 2010. 1) Gallucci, R.M., Sugawara, T., Yucesoy, B. et al.: Interleukin-6 treatment augments cutaneous wound healing in immunosuppressed mice. J. Interferon Cytokine Res., 21: 603-609, 2001. 2) Hashizume, M., Uchiyama, Y., Horai, N., et al.: Tocilizumab, a humanized antiinterleukin-6 receptor antibody, improved anemia in monkey arthritis by suppressing IL-6-induced hepcidin production. Rheumatol. Int., 30: 917-923, 2010. 4) Koike, R., Harigai, M., Atsumi, T., et al.: Japan College of Rheumatology 2009 guidelines for the use of tocilizumab, a humanized anti-interleukin-6 receptor monoclonal antibody, in rheumatoid arthritis. Mod. Rheumatol., 19: 351-357, 2009. 8) Nishimoto, N., Terao, K., Mima, T., et al.: Mechanisms and pathologic significances in increase in serum interleukin-6 (IL-6) and soluble IL-6 receptor after administration of an anti-IL-6 receptor antibody, tocilizumab, in patients with rheumatoid arthritis and Castleman disease. Blood, 112: 3959-3964, 2008. 3) Iizaka, S., Sanada, H., Matsui, Y., et al.: Serum albumin level is a limited nutritional marker for predicting wound healing in patients with pressure ulcer: Two multicenter prospective cohort studies. Clin. nurt., 30: 738-745, 2011. |
| References_xml | – reference: 2) Hashizume, M., Uchiyama, Y., Horai, N., et al.: Tocilizumab, a humanized antiinterleukin-6 receptor antibody, improved anemia in monkey arthritis by suppressing IL-6-induced hepcidin production. Rheumatol. Int., 30: 917-923, 2010. – reference: 6) Nishimoto, N.: Inerleukin-6 in rheumatoid arthtitis. Curr. Opin. Rheumatol., 18: 277-281, 2006. – reference: 3) Iizaka, S., Sanada, H., Matsui, Y., et al.: Serum albumin level is a limited nutritional marker for predicting wound healing in patients with pressure ulcer: Two multicenter prospective cohort studies. Clin. nurt., 30: 738-745, 2011. – reference: 1) Gallucci, R.M., Sugawara, T., Yucesoy, B. et al.: Interleukin-6 treatment augments cutaneous wound healing in immunosuppressed mice. J. Interferon Cytokine Res., 21: 603-609, 2001. – reference: 8) Nishimoto, N., Terao, K., Mima, T., et al.: Mechanisms and pathologic significances in increase in serum interleukin-6 (IL-6) and soluble IL-6 receptor after administration of an anti-IL-6 receptor antibody, tocilizumab, in patients with rheumatoid arthritis and Castleman disease. Blood, 112: 3959-3964, 2008. – reference: 5) Lin, Z.Q., Kondo, T., Ishida, Y. et al.: Essential involvement of IL-6 in the skin wound-healing process as evidenced by delayed wound healing in Il-6-dificient mice. J. Leukoc. Biol., 73: 713-721, 2003. – reference: 4) Koike, R., Harigai, M., Atsumi, T., et al.: Japan College of Rheumatology 2009 guidelines for the use of tocilizumab, a humanized anti-interleukin-6 receptor monoclonal antibody, in rheumatoid arthritis. Mod. Rheumatol., 19: 351-357, 2009. – reference: 7) Nishimoto, N., Ito K., Takagi, N.: Safety and efficacy profiles of tocilizumab monotherapy in Japanese patients with rheumatoid arthritis: meta-analysis of six initial trials and five long-term extensions. Mod. Rheumatol., 20: 222-232, 2010. |
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| SubjectTerms | anemia hypoalbuminemia pressure ulcer rheumatoid arthritis tocilizumab |
| Title | トシリズマブの投与により褥創の改善が得られた難治性関節リウマチの一例 |
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