Treatment of rheumatoid arthritis with biologics may exacerbate HTLV-1-associated conditions: A case report.
BACKGROUND
There are roughly 5 to 10 million persons infected with human T-lymphotropic virus type 1 (HTLV-1) worldwide, and the safety of treating this population with biologics remains poorly understood.


METHODS
An HTLV-1-infected 66-year-old female with HTLV-1 uveitis (HU) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Her HU had been in remission and her HAM/TSP symptoms had been managed effectively with oral steroids for years. However, she developed severe rheumatoid arthritis (RA) after failing to respond well to conventional anti-rheumatic agents.


METHODS
She was administered two intravenous 8mg/kg doses of the biologic tocilizumab.


RESULTS
Subsequently, her RA symptoms resolved, but she suffered a recurrence of HU and exacerbation of HAM/TSP symptoms. When she was switched back to steroid-based treatment, HU and HAM symptoms both improved, but RA symptoms again worsened. Finally, an attempt to substitute the biologic abatacept and reduce the steroids failed when HAM/TSP symptoms again became aggravated.


CONCLUSIONS
To the best of our knowledge, this represents the first report worldwide of a biologic aggravating HTLV-1-associated conditions. This report suggests that caution is advised when using biologics to treat HTLV-1-infected patients, though further research is required to clarify the situation.
Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo Miyata Eye Hospital, Miyazaki Yamano Clinic, Kagoshima Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kanagawa, Japan.
Yukiko
Y
Terada
Koju
K
Kamoi
Kyoko
K
Ohno-Matsui
Kazunori
K
Miyata
Chinami
C
Yamano
Ariella
A
Coler-Reilly
Yoshihisa
Y
Yamano
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D015490:HTLV-I Infections / Q000503:physiopathology*; D006801:Humans; D015493:Paraparesis, Tropical Spastic / Q000503:physiopathology; D014605:Uveitis / Q000382:microbiology / Q000503:physiopathology
D000305:Adrenal Cortex Hormones; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; C502936:tocilizumab