Tozawa Yusuke, Fujita Shouji, Abe Shuji, Kitamura Koichi, Kobayashi Ichiro
Department of Pediatrics, Goryokaku Hospital, Hakodate.
Pediatr Int. 2015 Apr;57(2):307-10. doi: 10.1111/ped.12454.
Recent advances in biologic therapy have enabled reduction of the progression of destructive arthritis in rheumatoid arthritis. Once destroyed, however, the affected bones and cartilage are not fully repaired. We describe the case of an 8-year-old girl with anti-citrullinated peptide antibody (ACPA)-positive polyarticular juvenile idiopathic arthritis (p-JIA). Destructive arthritis progressed during combination therapy with infliximab, methotrexate, mizoribine and prednisolone. Clinical remission was achieved, however, after switching the biologic agent to tocilizumab, a humanized monoclonal antibody to interleukin-6 receptor. Both bone erosion and bone marrow edema on magnetic resonance imaging were repaired in association with restoration of joint spaces. Furthermore, there was no relapse of arthritis on weekly methotrexate alone for 2 years after discontinuation of the tocilizumab. Tocilizumab led to radiological repair of both bone and cartilage destruction and long-term biologics-free remission in a patient with ACPA-positive p-JIA, and should be considered for tumor necrosis factor inhibitor-resistant cases.
生物治疗的最新进展已能够减缓类风湿关节炎中破坏性关节炎的进展。然而，一旦骨骼和软骨遭到破坏，就无法完全修复。我们描述了一名8岁抗瓜氨酸化肽抗体（ACPA）阳性多关节型幼年特发性关节炎（p-JIA）女孩的病例。在英夫利昔单抗、甲氨蝶呤、米唑立宾和泼尼松龙联合治疗期间，破坏性关节炎仍在进展。然而，在将生物制剂换为托珠单抗（一种抗白细胞介素-6受体的人源化单克隆抗体）后，实现了临床缓解。磁共振成像显示的骨侵蚀和骨髓水肿均随着关节间隙的恢复而得到修复。此外，停用托珠单抗后，仅使用每周一次的甲氨蝶呤治疗2年，关节炎未复发。托珠单抗使一名ACPA阳性p-JIA患者的骨和软骨破坏得到放射学修复，并实现了长期无生物制剂缓解，对于对肿瘤坏死因子抑制剂耐药的病例应考虑使用托珠单抗。
