Iwagaitsu Shiho, Naniwa Taio
Division of Rheumatology, Department of Internal Medicine, Nagoya City University Hospital, Nagoya, Japan.
Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Case Rep Rheumatol. 2017;2017:4580967. doi: 10.1155/2017/4580967. Epub 2017 Jun 6.
A 19-year-old Japanese woman with active Takayasu arteritis despite multiple conventional immunosuppressive therapies with glucocorticoids in combination with intravenous cyclophosphamide, azathioprine, or infliximab with methotrexate and tacrolimus was successfully treated by switching from infliximab to intravenous tocilizumab. Worsening of claudication of the legs and elevated acute phase reactants, including plasma pentraxin-3 levels, were observed during combination therapy with infliximab. Computed tomography demonstrated increased wall thickening with contrast enhancement in the preexisting lesion of the descending aorta and the femoral arteries. After switching from infliximab to tocilizumab, plasma pentraxin-3 levels gradually decreased to the normal range in parallel with the improvement of claudication. Follow-up computed tomographic scans confirmed the marked improvement of these arterial lesions. Moreover, plasma pentraxin-3 level was increased in response to the worsening of claudication that occurred just after switching to a subcutaneous tocilizumab injection. Measurements of plasma pentraxin-3 might be useful for evaluation of the vascular wall inflammation and therapeutic efficacy even during biologic therapy targeting tumor necrosis factor and interleukin-6.
一名19岁的日本女性，尽管接受了多种传统免疫抑制疗法，包括糖皮质激素联合静脉注射环磷酰胺、硫唑嘌呤，或英夫利昔单抗联合甲氨蝶呤和他克莫司，但仍患有活动性大动脉炎。通过将英夫利昔单抗换成静脉注射托珠单抗，该患者得到了成功治疗。在与英夫利昔单抗联合治疗期间，观察到患者腿部跛行加重，急性期反应物升高，包括血浆五聚素-3水平。计算机断层扫描显示，降主动脉和股动脉的原有病变处管壁增厚增加，且有对比增强。从英夫利昔单抗换成托珠单抗后，血浆五聚素-3水平逐渐降至正常范围，同时跛行症状改善。随访计算机断层扫描证实这些动脉病变有明显改善。此外，在换成皮下注射托珠单抗后不久出现跛行加重时，血浆五聚素-3水平升高。即使在针对肿瘤坏死因子和白细胞介素-6的生物治疗期间，检测血浆五聚素-3水平可能也有助于评估血管壁炎症和治疗效果。
