title: Three cases of previous smokers with rheumatoid arthritis who did not respond to tumor necrosis factor inhibitors were treated successfully with an anti-interleukin-6 receptor antibody.
abstract: We report three cases of previous smokers who did not respond to TNF inhibitors but who responded successfully to an anti-interleukin-6 receptor antibody (tocilizumab (TCZ)). Case 1 is a 63-year-old woman whose smoking index was 200 and had been complaining of polyarthralgia since 1996. She started treatment with etanercept due to high disease activity, but her DAS28-CRP was 4.2. She was therefore switched to TCZ, which dramatically improved her symptoms; her DAS28-CRP had decreased to 2.1. Case 2 is a 64-year-old man whose smoking index was 1600 and had been complaining of polyarthralgia since 2006. Because his DAS28-CRP score increased over time to 5.9, etanercept and adalimumab were added sequentially, but he showed no response over the course of two years. The patient was therefore switched to TCZ, which dramatically improved his symptoms: his DAS28-CRP decreased to 2.7. Case 3 is a 48-year-old woman whose smoking index was 560 and had been complaining of pain in both knee joints since 2001. She was treated with adalimumab due to high disease activity but showed no response over the course of 1.5 years. The patient was therefore switched to TCZ, and her DAS28-CRP decreased to 1.8. An IL-6 blockade might be suitable for treating these 3 cases of previous smokers.
authors: Iwata Orthopedics and Rheumatology Clinic, No. 13-5, 1A Nakasuji 8-Chome, Takarazuka, Hyogo 665-9874, Japan.
authors: Yasuo
authors: Y
authors: Iwata
references: Clin Rheumatol. 2009 Apr;28(4):485-7
references: 19184270
references: Eur Respir J. 1996 Oct;9(10):1989-94
references: 8902455
references: J Clin Rheumatol. 2010 Jan;16(1):15-8
references: 20051749
references: Tob Induc Dis. 2004 Jun 15;2(2):53-65
references: 19570272
references: J Clin Periodontol. 2012 Jul;39(7):599-607
references: 22530757
references: J Clin Periodontol. 1993 Mar;20(3):225-31
references: 8383708
references: J Rheumatol. 2009 Jun;36(6):1180-7
references: 19447930
references: Ann Rheum Dis. 2007 Sep;66(9):1162-7
references: 17485422
references: Science. 2010 Oct 1;330(6000):90-4
references: 20813919
references: J Periodontol. 2000 May;71(5):743-751
references: 29537517
references: Arthritis Rheum. 2011 Jan;63(1):26-36
references: 20862678
references: Science. 2010 Jan 29;327(5965):580-3
references: 20110505
references: Thromb Haemost. 1994 Aug;72(2):302-8
references: 7831669
references: Am J Health Promot. 2003 Nov-Dec;18(2):133-42
references: 14621408
references: Ann Rheum Dis. 2008 Oct;67(10):1488-92
references: 18413445
references: Ann Rheum Dis. 2009 Jan;68(1):153-4
references: 19088261
references: J Periodontol. 1998 Aug;69(8):899-910
references: 9736373
references: Clin Exp Rheumatol. 2010 Jan-Feb;28(1):141-2
references: 20346255
references: Clin Rheumatol. 2010 Dec;29(12):1465-7
references: 20734215
references: Arthritis Rheum. 1999 May;42(5):910-7
references: 10323446
references: J Interferon Cytokine Res. 2008 Aug;28(8):509-21
references: 18729741
references: Clin Exp Rheumatol. 2005 Nov-Dec;23(6):861-6
references: 16396705
references: Angiology. 2012 Jul;63(5):353-7
references: 21948974
references: J Clin Periodontol. 2005 Oct;32(10):1041-6
references: 16174266
references: Blood. 2001 Nov 1;98(9):2720-5
references: 11675343
references: Eur Respir J. 2003 Apr;21(4):589-93
references: 12762340
references: Ann Rheum Dis. 2011 Feb;70(2):390-2
references: 20650873
references: Scand J Rheumatol. 2012 Feb;41(1):1-9
references: 22118371
references: Circ J. 2006 Jan;70(1):8-13
references: 16377917