title: A case of rheumatoid pericarditis associated with a high IL-6 titer in the pericardial fluid and tocilizumab treatment.
abstract: We report a 60-year-old woman with rheumatoid arthritis complicated by pericarditis. Treatment with tocilizumab improved her polyarthritis, but the pericardial effusion increased so rapidly as to cause cardiac tamponade before the treatment could prove its efficacy. Pericardial effusion disappeared after pericardiocentesis. The pericardial fluid contained a remarkably high concentration of interleukin-6 (IL-6; 351,000 pg/mL), which tocilizumab appeared to have made yet higher compared to the reported IL-6 levels in rheumatoid pericarditis. No further exacerbation of pericarditis was observed after retreatment with tocilizumab. This case has important implications in that it suggests that the prominently elevated IL-6 level in pericardial fluid during tocilizumab treatment may be an indicator of its efficacy for pericarditis.
authors.affiliation: Department of Rheumatology and Clinical Immunology, Hirakata Hospital, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka 573-1191, Japan. ozakiy@takii.kmu.ac.jp
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ozaki
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tanaka
authors.forename: Keiko
authors.initials: K
authors.lastname: Shimamoto
authors.forename: Hideki
authors.initials: H
authors.lastname: Amuro
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Kawakami
authors.forename: Yonsu
authors.initials: Y
authors.lastname: Son
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ito
authors.forename: Takahiko
authors.initials: T
authors.lastname: Wada
authors.forename: Shosaku
authors.initials: S
authors.lastname: Nomura
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000008:administration & dosage; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood* / Q000276:immunology; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology; D010493:Pericarditis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology; D012216:Rheumatic Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology; D014057:Tomography, X-Ray Computed
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; C508600:IL6 protein, human; D015850:Interleukin-6; C502936:tocilizumab