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Treatment options for giant cell arteritis (GCA) are limited. Glucocorticoids are the mainstay of therapy, but relapses are common and often necessitate high cumulative doses of glucocorticoids.1,–,4 Interleukin 6 (IL-6) might be a key mediator of vascular inflammation in patients with GCA. Temporal artery biopsy samples show enhanced IL-6 production,5 and IL-6 levels generally correlate with disease activity.6 This prompted us to investigate the effects of anti-IL-6 receptor therapy with tocilizumab in three patients with refractory GCA.
Our first patient (79-year-old male) suffered from fever, night sweats and weight loss. Inflammation markers were elevated (C reactive protein (CRP) 168 mg/l), temporal artery biopsy showed typical histological signs and positron emission tomography (PET)/CT scans demonstrated large-vessel vasculitis (figure 1). Despite excellent initial response, we could not taper prednisone to doses less than 30 mg/day. Since methotrexate was contraindicated (chronic renal failure), we added azathioprine without clinical improvement.