Ultrasonographic resolution of the vessel wall oedema with modest clinical improvement in a large-vessel vasculitis patient treated with tocilizumab.
We report a 63-year-old man with large-vessel giant cell arteritis with affection of the aorta in its thoracal descendens and abdominal segments, both axillar arteries and the left carotid artery. The diagnosis was confirmed with positive biopsy of the temporal artery. The patient was treated with prednisolone at first and thereafter with methotrexate. Due to a moderate clinical response, tocilizumab at a dose of 8 mg/kg was added 8 weeks after diagnosis. The patient did not improve clinically, and the prednisolone dose could not be tapered rapidly as previously reported in small case series. Nevertheless, the wall oedema determined by ultrasonography in both axillar and left carotid arteries almost disappeared 2 months after tocilizumab initiation. Two months after the last tocilizumab, the patient relapsed clinically. Tocilizumab seems to be an effective therapy with faster resolution of the vessel wall oedema determined by ultrasonography by suppressing Th17-cell activity. But the clinical improvement in our patient has been moderate and short-lived due to persistent Th1 cells activity.
Department of Rheumatology, University Hospital of North Norway, Postboks 14, 9038 Tromsø, Norway. emilio.besada@unn.no
Emilio
E
Besada
Johannes C
JC
Nossent
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D001706:Biopsy; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D004487:Edema / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D013700:Giant Cell Arteritis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D013699:Temporal Arteries / Q000000981:diagnostic imaging* / Q000473:pathology; D018616:Ultrasonography, Doppler, Duplex
D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D011239:Prednisolone; C502936:tocilizumab; D001241:Aspirin; D008727:Methotrexate