Abstract
BackgroundMultiple sclerosis is a relatively rare disease, and complications of multiple sclerosis and rheumatoid arthritis are much rarer. Since anti-tumor necrosis factor therapy increases exacerbations of multiple sclerosis, complications of demyelinating diseases contraindicate anti-tumor necrosis factor therapy. There have been few reports of anti-interleukin-6 receptor therapy for patients with rheumatoid arthritis complicated with multiple sclerosis.Case presentationA 53-year-old Japanese woman with multiple sclerosis and rheumatoid arthritis was admitted to our hospital because her rheumatoid arthritis was uncontrolled with oral methotrexate, tacrolimus, and prednisolone. She had developed multiple sclerosis when she was 25 years old and was treated with glucocorticoid therapy. Her multiple sclerosis was in remission for more than 9 years. Because anti-tumour necrosis factor therapy can exacerbate demyelinating disease, the anti-interleukin-6 receptor antibody tocilizumab was started at 8 mg/kg every 4 weeks. At the second administration of tocilizumab, complete remission was achieved. She has remained in remission with tocilizumab without recurrence of multiple sclerosis for more than 5 years.ConclusionAnti-interleukin-6 therapy was safely used in this patient with rheumatoid arthritis without exacerbations of multiple sclerosis.
Highlights
Multiple sclerosis is a relatively rare disease, and complications of multiple sclerosis and rheumatoid arthritis are much rarer
Anti-interleukin-6 therapy was safely used in this patient with rheumatoid arthritis without exacerbations of multiple sclerosis
The mechanisms of demyelinating disease induced by anti-tumour necrosis factor (TNF) therapy are not clear, but inhibition of TNF leads to IFN-γ production, which is associated with Multiple sclerosis (MS) [11]
Summary
Multiple sclerosis (MS) is an autoimmune, inflammatory, demyelinating disease of the central nervous system characterised by repeated relapses and remissions. Case presentation A 53-year-old Japanese woman was admitted to Niigata Rheumatic Centre, Shibata city, Japan She had been diagnosed with MS associated with right optic neuritis and thoracic myelitis when she was 25 years old and treated with high-dose prednisolone (PSL). The MS achieved remission and PSL was stopped for 9 years When she was 50 years old, polyarthritis developed, and rheumatoid factor and C-reactive protein (CRP) levels were high. Serum interferon (IFN) -γ was negative (≤0.1 IU/mL) and serum high sensitivity TNF-α was within normal range (1.6 pg/mL) before starting TCZ therapy. Both of them kept the same levels for a year. Serum IL-6 level was elevated, 51.2 pg/mL (normal range; ≤4.0 pg/mL) before starting TCZ therapy and it was 57.1 pg/mL a year later
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