Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
Rheumatology (Oxford). 2010 Dec;49(12):2408-12. doi: 10.1093/rheumatology/keq275. Epub 2010 Sep 5.
SSc is an autoimmune disease characterized by fibrosis of the skin and internal organs. Although the aetiology remains uncertain, many reports have suggested that IL-6 is involved in SSc pathogenesis. Tocilizumab, an anti-IL-6 receptor antibody, is an anti-arthritis medicine that works through the blockade of IL-6 functions. To examine the effect of tocilizumab on SSc, we administered tocilizumab to two SSc patients.
Two dcSSc patients were administered tocilizumab at 8 mg/kg once a month for 6 months. One patient had pulmonary fibrosis assessed by CT and spirometry, and the other had chronic renal failure caused by scleroderma renal crisis. Their skin condition was monitored with a Vesmeter and the modified Rodnan total skin score (mRTSS). Skin biopsies were obtained before and after the tocilizumab treatment to investigate the histological changes.
After tocilizumab treatment, both patients showed softening of the skin with reductions of 50.7 and 55.7% in the total z-score of Vesmeter hardness and 51.9 and 23.0% in the mRTSS, respectively. Histological examination showed thinning of the collagen fibre bundles in the dermis. The creatinine clearance in the patient with chronic renal failure improved from 38 to 55 ml/min. However, the fibrotic changes in the lung in the other patient remained unchanged.
In the two cases of SSc that we report here, softening of the skin was observed during the treatment with tocilizumab.
硬皮病（SSc）是一种自身免疫性疾病，其特征为皮肤和内脏纤维化。尽管病因仍不确定，但许多报告表明白细胞介素 6（IL-6）参与了 SSc 的发病机制。托珠单抗是一种抗 IL-6 受体抗体，是一种抗关节炎药物，通过阻断 IL-6 功能发挥作用。为了研究托珠单抗对 SSc 的疗效，我们对两名 SSc 患者使用了托珠单抗进行治疗。
两名弥漫性硬皮病（dcSSc）患者每月接受一次 8mg/kg 的托珠单抗治疗，共 6 个月。一名患者的肺部纤维化通过 CT 和肺功能检查评估，另一名患者因硬皮病肾危象导致慢性肾衰竭。他们的皮肤状况通过 Vesmeter 和改良的 Rodnan 总皮肤评分（mRTSS）进行监测。在托珠单抗治疗前后进行皮肤活检，以研究组织学变化。
托珠单抗治疗后，两名患者的皮肤均变软，Vesmeter 硬度总 Z 评分分别降低了 50.7%和 55.7%，mRTSS 分别降低了 51.9%和 23.0%。组织学检查显示真皮胶原纤维束变薄。慢性肾衰竭患者的肌酐清除率从 38ml/min 改善至 55ml/min。然而，另一名患者肺部的纤维化改变仍未改变。
在我们报告的这两例 SSc 病例中，在托珠单抗治疗期间观察到皮肤变软。
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