Sequential Tocilizumab and Tofacitinib Treatment for Systemic Juvenile Idiopathic Arthritis: a Case Report
Abstract Systemic juvenile idiopathic arthritis (sJIA) is a complex and difficult to cure condition with high disability and mortality rates. Herein, we report the case of a patient with sJIA who was treated with sequential tocilizumab (TCZ) and tofacitinib treatment. The patient was a 4-year-old gi...
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| Format: | Article |
| Language: | English |
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Adis, Springer Healthcare
2022-11-01
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| Series: | Rheumatology and Therapy |
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| Online Access: | https://doi.org/10.1007/s40744-022-00496-z |
| _version_ | 1797863640632655872 |
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| author | Ye Zhang Jinli Ru Jinxiu Zhang |
| author_facet | Ye Zhang Jinli Ru Jinxiu Zhang |
| author_sort | Ye Zhang |
| collection | DOAJ |
| description | Abstract Systemic juvenile idiopathic arthritis (sJIA) is a complex and difficult to cure condition with high disability and mortality rates. Herein, we report the case of a patient with sJIA who was treated with sequential tocilizumab (TCZ) and tofacitinib treatment. The patient was a 4-year-old girl hospitalised with fever accompanied by multiple joint swelling and pain in June 2020. Laboratory tests revealed a white blood cell count of 15.3 × 109/L, platelet count of 676.8 × 109/L, haemoglobin of 91.8 g/L, serum ferritin level of 1103.8 U/L, erythrocyte sedimentation rate of 85.0 mm/h, C-reactive protein level of 146.0 g/L and interleukin (IL)-6 level of 288.0 pg/ml. Rheumatoid factor and autoantibodies test results were negative, and she was diagnosed with sJIA. The patient was started on a combination of ibuprofen, methotrexate and TCZ, and her fever decreased to the normal range without any recurrence. Painful joint swelling had resolved significantly at 3-month follow-up. Janus kinase (JAK) inhibitors inhibit the effects of several cytokines, particularly IL-6, and are economical and convenient. Therefore, we selected tofacitinib to replace TCZ in this case, while the other drugs remained unchanged. Arthritis symptoms disappeared gradually after 9-month follow-up. In May 2021, the patient was hospitalised owing to a slight recurrence of the upper respiratory tract infection. She was administered one intravenous infusion of TCZ along with a switch to oral tofacitinib, which quickly relieved the symptoms. In March 2022, the patient’s condition was stable. The curative effect of sequential TCZ and tofacitinib treatment was remarkable. IL-6 inhibitors sequential to JAK inhibitors could be a new option in the treatment of systemic juvenile idiopathic joints. |
| first_indexed | 2024-04-09T22:38:47Z |
| format | Article |
| id | doaj.art-ef11fb7292334b6fa22042f18f0e5b88 |
| institution | Directory Open Access Journal |
| issn | 2198-6576 2198-6584 |
| language | English |
| last_indexed | 2024-04-09T22:38:47Z |
| publishDate | 2022-11-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Rheumatology and Therapy |
| spelling | doaj.art-ef11fb7292334b6fa22042f18f0e5b882023-03-22T12:20:49ZengAdis, Springer HealthcareRheumatology and Therapy2198-65762198-65842022-11-0110129330010.1007/s40744-022-00496-zSequential Tocilizumab and Tofacitinib Treatment for Systemic Juvenile Idiopathic Arthritis: a Case ReportYe Zhang0Jinli Ru1Jinxiu Zhang2Department of General Medicine, The Second Hospital of Shanxi Medical University (The Second Clinical Medical College of Shanxi Medical University, Shanxi Red Cross Hospital)Department of General Medicine, The Second Hospital of Shanxi Medical University (The Second Clinical Medical College of Shanxi Medical University, Shanxi Red Cross Hospital)Department of General Medicine, The Second Hospital of Shanxi Medical University (The Second Clinical Medical College of Shanxi Medical University, Shanxi Red Cross Hospital)Abstract Systemic juvenile idiopathic arthritis (sJIA) is a complex and difficult to cure condition with high disability and mortality rates. Herein, we report the case of a patient with sJIA who was treated with sequential tocilizumab (TCZ) and tofacitinib treatment. The patient was a 4-year-old girl hospitalised with fever accompanied by multiple joint swelling and pain in June 2020. Laboratory tests revealed a white blood cell count of 15.3 × 109/L, platelet count of 676.8 × 109/L, haemoglobin of 91.8 g/L, serum ferritin level of 1103.8 U/L, erythrocyte sedimentation rate of 85.0 mm/h, C-reactive protein level of 146.0 g/L and interleukin (IL)-6 level of 288.0 pg/ml. Rheumatoid factor and autoantibodies test results were negative, and she was diagnosed with sJIA. The patient was started on a combination of ibuprofen, methotrexate and TCZ, and her fever decreased to the normal range without any recurrence. Painful joint swelling had resolved significantly at 3-month follow-up. Janus kinase (JAK) inhibitors inhibit the effects of several cytokines, particularly IL-6, and are economical and convenient. Therefore, we selected tofacitinib to replace TCZ in this case, while the other drugs remained unchanged. Arthritis symptoms disappeared gradually after 9-month follow-up. In May 2021, the patient was hospitalised owing to a slight recurrence of the upper respiratory tract infection. She was administered one intravenous infusion of TCZ along with a switch to oral tofacitinib, which quickly relieved the symptoms. In March 2022, the patient’s condition was stable. The curative effect of sequential TCZ and tofacitinib treatment was remarkable. IL-6 inhibitors sequential to JAK inhibitors could be a new option in the treatment of systemic juvenile idiopathic joints.https://doi.org/10.1007/s40744-022-00496-zSystemic juvenile idiopathic arthritisTocilizumabTofacitinibSequential treatment |
| spellingShingle | Ye Zhang Jinli Ru Jinxiu Zhang Sequential Tocilizumab and Tofacitinib Treatment for Systemic Juvenile Idiopathic Arthritis: a Case Report Rheumatology and Therapy Systemic juvenile idiopathic arthritis Tocilizumab Tofacitinib Sequential treatment |
| title | Sequential Tocilizumab and Tofacitinib Treatment for Systemic Juvenile Idiopathic Arthritis: a Case Report |
| title_full | Sequential Tocilizumab and Tofacitinib Treatment for Systemic Juvenile Idiopathic Arthritis: a Case Report |
| title_fullStr | Sequential Tocilizumab and Tofacitinib Treatment for Systemic Juvenile Idiopathic Arthritis: a Case Report |
| title_full_unstemmed | Sequential Tocilizumab and Tofacitinib Treatment for Systemic Juvenile Idiopathic Arthritis: a Case Report |
| title_short | Sequential Tocilizumab and Tofacitinib Treatment for Systemic Juvenile Idiopathic Arthritis: a Case Report |
| title_sort | sequential tocilizumab and tofacitinib treatment for systemic juvenile idiopathic arthritis a case report |
| topic | Systemic juvenile idiopathic arthritis Tocilizumab Tofacitinib Sequential treatment |
| url | https://doi.org/10.1007/s40744-022-00496-z |
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