title: Tocilizumab Efficacy in a Patient with Positive Anti-CCP Chronic Lyme Arthritis.
abstract: BACKGROUND
  Lyme arthritis, a manifestation of tick-borne Lyme disease, can prove to be refractory to classic treatment.
  
  
  METHODS
  We present a case of a 48-year-old male, diagnosed with chronic Lyme arthritis, refractory to recurrent and prolonged courses of doxycycline, ceftriaxone, as well as hydroxychloroquine and methotrexate. The patient responded partially to tumor necrosis factor (TNF)-alpha blockade by etanercept and, finally, entered long-term remission after his treatment was switched to tocilizumab.
  
  
  CONCLUSIONS
  Off label treatment by biologic disease modifying antirheumatic drugs can be considered in selected patients with severe antibiotic-resistant Lyme arthritis.C.
authors.affiliation: Department of Medicine , Technion Institute of Technology , Bnai Zion Medical Center, Haifa , Israel.
authors.forename: Julianna
authors.initials: J
authors.lastname: Hirsch
authors.affiliation: Department of Medicine, Technion Institute of Technology, Bnai Zion Medical Center, Haifa, Israel; Department of Rheumatology, Bnai Zion Medical Center, Haifa, Israel.
authors.forename: Itzhak
authors.initials: I
authors.lastname: Rosner
authors.affiliation: Department of Medicine, Technion Institute of Technology, Bnai Zion Medical Center, Haifa, Israel; Department of Rheumatology, Bnai Zion Medical Center, Haifa, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Rimar
authors.affiliation: Department of Medicine, Technion Institute of Technology, Bnai Zion Medical Center, Haifa, Israel; Department of Rheumatology, Bnai Zion Medical Center, Haifa, Israel.
authors.forename: Lisa
authors.initials: L
authors.lastname: Kaly
authors.affiliation: Department of Medicine, Technion Institute of Technology, Bnai Zion Medical Center, Haifa, Israel; Department of Rheumatology, Bnai Zion Medical Center, Haifa, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Rozenbaum
authors.affiliation: Department of Medicine, Technion Institute of Technology, Bnai Zion Medical Center, Haifa, Israel; Department of Rheumatology, Bnai Zion Medical Center, Haifa, Israel.
authors.forename: Nina
authors.initials: N
authors.lastname: Boulman
authors.affiliation: Department of Medicine, Technion Institute of Technology, Bnai Zion Medical Center, Haifa, Israel; Department of Internal Medicine A, Bnai Zion Medical Center, Haifa, Israel.
authors.forename: Gleb
authors.initials: G
authors.lastname: Slobodin
keywords: Lyme arthritis; lyme disease; tocilizumab