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Tofacitinib for polyarteritis nodosa: a tailored therapy
  1. Doron Rimar1,
  2. Ayelet Alpert2,
  3. Elina Starosvetsky2,
  4. Itzhak Rosner1,
  5. Gleb Slobodin1,
  6. Michael Rozenbaum1,
  7. Lisa Kaly1,
  8. Nina Boulman1,
  9. Abid Awisat1,
  10. Shira Ginsberg1,
  11. Karina Zilber1,
  12. Shai S Shen-Orr2,3
  1. 1Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion—Israel Institute of Technology, Haifa, Israel
  2. 2Department of Immunology, Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
  3. 3Faculty of Biology, Technion—Israel Institute of Technology, Haifa, Israel
  1. Correspondence to Dr Doron Rimar, Rheumatology Unit, Bnai Zion Medical Center, POB 4940, Haifa 31048, Israel; doronrimar{at}gmail.com

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Tofacitinib is a novel inhibitor of Janus kinase (JAK) 3 and JAK1 is recently introduced as treatment for rheumatoid arthritis.1 The JAK inhibitors are at the focus of research in a myriad of other inflammatory diseases2 ,3 as the JAK-(signal transducer and activator of transcription) STAT pathway has a central role in cytokine signal transduction. We herein describe a case of refractory polyarteritis nodosa (PAN) successfully treated with tofacitinib.

A 28-year-old man had been diagnosed with PAN at age 14. He presented with livedo reticularis, arthritis and skin nodules with arteritis/fibrinoid necrosis confirmed on biopsy. Immunological panel at the time of diagnosis was negative for antineutrophil cytoplasmic antibodies, anti-nuclear antibodies, anti-Ro/SS-A antibodies, anti-La/SS-B antibodies, rheumatoid factor, with normal complement levels. He was treated with azathioprine and methotrexate for several years with drug-controlled complete remission. At age 24, his disease flared and he began to suffer from necrotic lesions of the scrotum and calves, excruciating abdominal pain and polyarthritis, with high C-reactive protein (CRP) levels (160–300 mg/L) for which he received recurrent intravenous methylprednisolone pulses and oral …

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