Rheumatology Service of Hospital Nossa Senhora da Conceição - Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil.
Clin Exp Rheumatol. 2012 Jan-Feb;30(1 Suppl 70):S98-100. Epub 2012 May 11.
A 28-year-old patient with Takayasu's arteritis (TA) failed to respond to high doses of prednisone in combination with methotrexate, pulses of cyclophosphamide and methylprednisolone, azathioprine, mycophenolate mofetil, adalimumab and monthly infusions of infliximab 5 mg/kg. After the beginning of tocilizumab therapy (4-8 mg/kg at monthly infusions), an impressive improvement in clinical and laboratory parameters of disease activity occurred, allowing the reduction of prednisone dose from 30 to 5 mg/day. However, after the 8th dose the patient developed symptoms of vertebrobasilar insufficiency, despite maintaining a good clinical condition and normal values of inflammatory markers. Angio-computed tomography repeated at one year of therapy showed reduction in aortic wall thickness, but also narrowing of the luminal diameters of the right subclavian, renal arteries, and left vertebral artery. Therefore, despite a significant clinical and laboratory improvement, vascular disease may progress in aortic branches in TA patients under tocilizumab therapy.
一位 28 岁的 Takayasu 动脉炎（TA）患者在接受大剂量泼尼松联合甲氨蝶呤、环磷酰胺和甲基强的松龙脉冲治疗、硫唑嘌呤、霉酚酸酯、阿达木单抗和每月 5mg/kg 的英夫利昔单抗输注治疗后，未能得到缓解。在开始使用托珠单抗治疗（每月 4-8mg/kg 输注）后，疾病活动的临床和实验室参数显著改善，使泼尼松剂量从 30mg 减至 5mg/天。然而，在第 8 次输注后，患者出现椎基底动脉供血不足的症状，尽管临床状况良好且炎症标志物的数值正常。治疗一年时重复的血管计算机断层扫描显示主动脉壁厚度减少，但右侧锁骨下动脉、肾动脉和左侧椎动脉的管腔直径也变窄。因此，尽管临床和实验室检查显著改善，但在托珠单抗治疗下，TA 患者的主动脉分支的血管疾病可能会进展。
