Tada Yoshifumi, Maeyama Akira, Hagio Tomonobu, Sakai Mariko, Maruyama Akihito, Yamamoto Takuaki
Department of Rheumatology, Faculty of Medicine, Saga University, Saga, Japan.
Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Case Rep Rheumatol. 2023 Nov 6;2023:5780733. doi: 10.1155/2023/5780733. eCollection 2023.
Lymphoproliferative disorders (LPDs) are serious complications associated with rheumatoid arthritis (RA) treatment that mostly occur during methotrexate (MTX) treatment. Cessation of MTX may induce regression of LPDs but is often followed by a flare of RA. Here, we describe two patients with RA flares after the discontinuation of MTX due to LPDs and sarilumab was useful for the treatment of RA without a relapse of LPDs. Patient 1 was an 84-year-old woman, who developed an LPD in the pharyngeal region after 7 years of MTX treatment. Discontinuation of MTX induced regression of LPD but RA flared within 6 months. Administration of sarilumab, in addition to salazosulfapyridine and prednisolone, reduced the RA activity without LPD relapse. Patient 2 was a 76-year-old man, who developed LPD in the pharyngeal region after 5 years of MTX treatment. Discontinuation of MTX induced regression of LPD, but soon RA flared. Although treatment with tocilizumab (TCZ) was effective in controlling RA, it flared again after 2 years. TCZ was switched to sarilumab and RA was in remission. LPD did not recur during these periods.
淋巴增殖性疾病（LPDs）是类风湿关节炎（RA）治疗相关的严重并发症，大多发生在甲氨蝶呤（MTX）治疗期间。停用MTX可能会使LPDs消退，但随后常出现RA病情复发。在此，我们描述了两名因LPDs停用MTX后出现RA病情复发的患者，而沙瑞鲁单抗对治疗RA有效且未出现LPDs复发。患者1是一名84岁女性，在接受MTX治疗7年后出现咽部LPDs。停用MTX使LPDs消退，但6个月内RA病情复发。除柳氮磺胺吡啶和泼尼松龙外，加用沙瑞鲁单抗降低了RA活动度且未出现LPDs复发。患者2是一名76岁男性，在接受MTX治疗5年后出现咽部LPDs。停用MTX使LPDs消退，但很快RA病情复发。尽管用托珠单抗（TCZ）治疗对控制RA有效，但2年后病情再次复发。将TCZ换为沙瑞鲁单抗后RA病情缓解。在此期间LPDs未复发。
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