title: Refractory PMR with aortitis: life-saving treatment with anti-IL6 monoclonal antibody (tocilizumab) and surgical reconstruction of the ascending aorta.
abstract: Aortitis is uncommon but well described in patients with polymyalgia rheumatica (PMR). While glucocorticoid remains the mainstay therapy for large-vessel vasculitis, there have been cases where tocilizumab therapy led to clinical and serological improvement in patients with relapsing or refractory disease. We report a case of life-threatening PMR with aortitis in the absence of manifestations related to giant cell arteritis, which, having failed to respond to corticosteroid therapy, was successfully treated with tocilizumab and emergency reconstruction of the ascending aorta. This case adds to the literature supporting the potential value of interleukin-6 inhibition in rare rheumatological conditions such as inflammatory aortitis.
authors.affiliation: Department of Rheumatology, University Hospital Limerick, Limerick, Ireland. fahd_adeeb@yahoo.com
authors.forename: Fahd Adeeb Mohamed
authors.initials: FA
authors.lastname: Ashraf
authors.forename: Shakeel
authors.initials: S
authors.lastname: Anjum
authors.forename: Abid
authors.initials: A
authors.lastname: Hussaini
authors.forename: Alexander
authors.initials: A
authors.lastname: Fraser
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001011:Aorta / Q000601:surgery*; D001025:Aortitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D015850:Interleukin-6 / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011111:Polymyalgia Rheumatica / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D015850:Interleukin-6; C502936:tocilizumab