接受托珠单抗治疗的
类风湿关节炎患者的加速性皮下结节
背景托珠单抗是一种针对白细胞介素-6受体的单克隆抗体，已被批准用于治疗中重度类风湿关节炎。作者发现，它可以预防类风湿关节炎患者的肺部和皮下结节，但据我们所知，目前还没有关于托珠单抗治疗期间皮下结节加速的数据。案例陈述我们首次报道了5例RA患者的小型病例：1例46岁白人女性、1例70岁白人女性、1例63岁白人女性、1例69岁白人男性和1例72岁白人女性（平均年龄64±10.6岁）；患者在接受托珠单抗静脉注射治疗期间出现皮下结节恶化的现象。5例患者中有4例类风湿因子呈阳性，有5例抗瓜氨酸肽抗体呈阳性。所有患者之前均接受过各种常规和生物药物治疗；在我们的观察中，3例患者服用甲氨蝶呤，2例服用羟氯喹，4例服用泼尼松。每4周静脉注射一次托珠单抗8mg/kg，平均用药时间为43.4±32.4个月，有3例患者疾病控制良好。所有患者均有皮下结节病史，在托珠单抗治疗期间病情显著恶化，手指、肘部或乳房下皱襞出现新结节，并趋于溃疡。该医疗事件的管理包括停用甲氨蝶呤、使用类固醇、添加使用羟氯喹或秋水仙碱、使用抗生素和进行手术。然而，药物和手术治疗均不完全有效，因为结节趋于复发，且数量和大小也会增加。"结论据我们所知，这是第一份描述接受托珠单抗治疗的类风湿关节炎患者的小型病例系列中加速性皮下结节形成的报告。原文Acceleratedsubcutaneousnodulosisinpatientswithrheumatoidarthritistreatedwithtocilizumab:acaseseries
Background
Tocilizumabisamonoclonalantibodydirectedagainsttheinterleukin-6receptor,whichisapprovedforthetreatmentofmoderate-to-severerheumatoidarthritis.Authorshavefoundthatitpreventslungandsubcutaneousnodulosisinpatientswithrheumatoidarthritisbut,tothebestofourknowledge,therearenodataconcerningtheaccelerationofsubcutaneousnodulosisduringtocilizumabtherapy.
Casepresentation
Wereportforthefirsttimeasmallcaseseriesoffivepatientswithrheumatoidarthritis:a46-year-oldwhitewoman,a70-year-oldwhitewoman,a63-year-oldwhitewoman,a69-year-oldwhiteman,anda72-year-oldwhitewoman(meanage64±10.6years);theyexperiencedworseningsubcutaneousnodulosisduringtreatmentwithintravenouslyadministeredtocilizumab.
Fourofthefivepatientswerepositiveforrheumatoidfactorandfiveforanti-citrullinatedpeptideantibodies.Allofthepatientshadpreviouslybeentreatedwithvariousconventionalandbiologicaldrugs;atthetimeofourobservation,threeweretakingmethotrexate,twohydroxychloroquine,andfourweretakingprednisone.Tocilizumab8mg/kgwasadministeredintravenouslyevery4weeksforameanof43.4±32.4months,andledtogooddiseasecontrolinthreecases.Allofthepatientshadahistoryofsubcutaneousnodulosis,whichconsiderablyworsenedduringtocilizumabtreatment,withthedevelopmentofnewnodulesontheirfingers,elbows,orintheinframammaryfold,tendingtoulcerate.Themanagementofthismedicaleventincludeddiscontinuationofmethotrexate,theadministrationofsteroids,theadditionofhydroxychloroquineorcolchicine,theuseofantibiotics,andsurgery.However,neitherpharmacologicalnorsurgicaltreatmentwas
