Granuloma annulare development in a patient with rheumatoid arthritis treated with tocilizumab: case-based review
Granuloma annulare development in a patient with rheumatoid arthritis treated with tocilizumab: case-based review
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使用托珠单抗治疗的类风湿性关节炎患者发生环形肉芽肿：基于病例的回顾
DOI：
10.1007/s00296-018-4212-0
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发表时间：
2018
影响因子：
4
通讯作者：
A. Drosos
中科院分区：
文献类型：
--
作者：
E. Pelechas;A. Papoudou;P. Voulgari;A. Drosos
环状肉芽肿（GA）是最常见的非感染性疾病。尽管它是一种良性疾病，但它可能与多种疾病和某些药物有关，包括生物疾病缓解抗风湿药物（bDMARD）。一名50岁男性，有甲氨蝶呤、羟氯喹和英夫利西单抗难治性类风湿性关节炎病史，接受托珠单抗（TCZ）治疗，一种白细胞介素-6受体拮抗剂，每周皮下注射162 mg。患者对TCZ治疗反应良好，急性期反应物减少，28个关节计数的疾病活动评分降低。然而，3个月后，他发生了影响下肢的多发性多环皮疹，与经皮肤活检证实的GA诊断一致。已停用TCZ，患者接受泼尼松治疗，4周后皮肤表现完全消退。这是TCZ治疗期间GA发展的第一例。因此，我们回顾了文献，并讨论了相关的情况下，GA的发展与bDMARDs治疗的患者。在处理接受这些药物治疗的患者时，所有医生都应了解可能的不良事件和此类并发症的潜在发展。
Granuloma annulare (GA) is the most common non-infectious disease. Despite the fact that it is a benign disease, it can be associated with a variety of disorders and certain drugs including biological disease-modifying anti-rheumatic drugs (bDMARDs). A 50-year-old man with a history of rheumatoid arthritis refractory to methotrexate, hydroxychloroquine and infliximab was treated with tocilizumab (TCZ), an interleukin-6 receptor antagonist, 162 mg subcutaneously every week. The patient responded very well to TCZ treatment with a decrease of acute phase reactants and reduction of disease activity score for 28-joints count. However, 3 months later he developed erythematous polycyclic eruptions affecting the lower extremities consistent with a diagnosis of GA which was confirmed by a skin biopsy. TCZ has been discontinued and the patient was treated with prednisone presenting complete resolution of skin manifestations after 4 weeks. This is the first case of GA development during TCZ treatment. Thus, we review the literature and discuss the relevant cases of GA development in patients treated with bDMARDs. When dealing with patients treated with these agents, all physicians should be aware of possible adverse events and the potential development of such complications.