Background Diagnosis of Rhupus bases on the combination of inflammatory symmetrical erosive polyarthritis and clinical features of SLE. For patients whose disease is resistant to or dependent on corticosteroids, methotrexate (MTX) and azathioprine (AZA), anti-TNF have been used as steroid-sparing second-line treatment with conflicting results. While MTX seems to be effective in controlling symptoms, data on AZA remains controversial, while the TNF-blocking agents proved to be ineffective in inducing or maintaining disease remission.
Objectives Two cases of refractory Rhupus who were at high risk of long lasting high dose of CS and were successfully treated with humanised anti-IL-6 receptor antibody, Tocilizumab (TCZ), given monthly at the dose of 8 mg/kg.
Methods Two women 59 and 51 year-old were treated. Disease duration was 14 and 19 years, respectively. They were refractory or intolerant to several agents, including Hydroxychloroquine, Sulfosalazina, Methotrexate, Leflunomide, Mycophenolate Mofetil, anti-TNF agents, Abatacept, and anti-CD20 monoclonal antibodies. The patients weregiven monthly infusions of Tocilizumab with dramatic improvement in symptoms already after the first dose.
Results Twenty-three and eleven months later both patients remain in complete clinical remission with normal values of Erythrocyte Sedimentation Rate and C Reactive Protein, negative anti-DNA, no swollen or painful joints, and negative power doppler sonography.
Conclusions In conclusion, TCZ could be a steroid-sparing agent in patients with Rhupus, and could be considered as a therapeutic option for patients who do not respond to standard therapy.
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Disclosure of Interest None Declared