From the Al Adan Hospital, Ahmadi, Kuwait.
J Clin Rheumatol. 2013 Oct;19(7):400-1. doi: 10.1097/RHU.0b013e3182a6aa0e.
Despite their disadvantages, glucocorticoids (GCs) remain a mainstay of therapy for polymyalgia rheumatica (PMR). Second-line antirheumatic and immune-modulatory drugs are not infrequently required because of disease relapses during GC tapering and GC adverse effects. Therapy with methotrexate or with an anti-tumor necrosis factor drug showed modest efficacy in this situation. Tocilizumab (TCZ) is an anti-interleukin 6 receptor antibody that is being recently studied in the treatment of PMR patients who are intolerant or refractory to GCs, especially after failure of a second-line agent. We report a case of PMR in which GCs were stopped because of adverse effects despite good response. The condition responded to neither methotrexate nor etanercept. Treatment with TCZ has led to significant improvement of the patient's clinical and biochemical PMR activity parameters, and she was kept in a solid remission for 1 year without any TCZ-related adverse effects. Tocilizumab is a promising drug in the management of PMR. Further studies are required to clearly define the indications and duration of TCZ therapy in the management of PMR.
尽管存在一些缺点，但糖皮质激素（GCs）仍然是治疗巨细胞动脉炎（PMR）的主要方法。由于在 GCs 减量过程中疾病复发和 GC 不良反应，经常需要使用二线抗风湿和免疫调节药物。在这种情况下，甲氨蝶呤或抗肿瘤坏死因子药物治疗显示出适度的疗效。托珠单抗（TCZ）是一种抗白细胞介素 6 受体抗体，最近正在研究用于对 GCs 不耐受或有抗药性的 PMR 患者，尤其是在二线药物治疗失败后。我们报告了一例 PMR 病例，尽管反应良好，但由于不良反应而停止使用 GCs。该病症对甲氨蝶呤和依那西普均无反应。TCZ 治疗导致患者的临床和生化 PMR 活动参数显著改善，并且在 1 年内没有任何与 TCZ 相关的不良反应，患者保持稳定缓解。托珠单抗是治疗 PMR 的一种有前途的药物。需要进一步的研究来明确 TCZ 治疗 PMR 的适应证和疗程。
