title: Tocilizumab treatment safety in rheumatoid arthritis in a patient with multiple sclerosis: a case report.
abstract: BACKGROUND
  Multiple sclerosis is a relatively rare disease, and complications of multiple sclerosis and rheumatoid arthritis are much rarer. Since anti-tumor necrosis factor therapy increases exacerbations of multiple sclerosis, complications of demyelinating diseases contraindicate anti-tumor necrosis factor therapy. There have been few reports of anti-interleukin-6 receptor therapy for patients with rheumatoid arthritis complicated with multiple sclerosis.
  
  
  METHODS
  A 53-year-old Japanese woman with multiple sclerosis and rheumatoid arthritis was admitted to our hospital because her rheumatoid arthritis was uncontrolled with oral methotrexate, tacrolimus, and prednisolone. She had developed multiple sclerosis when she was 25 years old and was treated with glucocorticoid therapy. Her multiple sclerosis was in remission for more than 9 years. Because anti-tumour necrosis factor therapy can exacerbate demyelinating disease, the anti-interleukin-6 receptor antibody tocilizumab was started at 8 mg/kg every 4 weeks. At the second administration of tocilizumab, complete remission was achieved. She has remained in remission with tocilizumab without recurrence of multiple sclerosis for more than 5 years.
  
  
  CONCLUSIONS
  Anti-interleukin-6 therapy was safely used in this patient with rheumatoid arthritis without exacerbations of multiple sclerosis.
authors.affiliation: Department of Rheumatology, Niigata Rheumatic Center, 1-2-8 Honcho, Shibata City, Niigata 957-0054, Japan. hiroe-212@umin.ac.jp.
authors.forename: Hiroe
authors.initials: H
authors.lastname: Sato
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kobayashi
authors.forename: Asami
authors.initials: A
authors.lastname: Abe
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ito
authors.forename: Hajime
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Nakazono
authors.forename: Akira
authors.initials: A
authors.lastname: Murasawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kuroda
authors.forename: Masaaki
authors.initials: M
authors.lastname: Nakano
authors.forename: Ichiei
authors.initials: I
authors.lastname: Narita
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy*; D012074:Remission Induction
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C502936:tocilizumab