TY - JOUR T1 - Anti-interleukin 6 receptor therapy as rescue treatment for giant cell arteritis JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis DO - 10.1136/ard.2010.149351 SP - annrheumdis149351 AU - Christian Beyer AU - Roland Axmann AU - Enijad Sahinbegovic AU - Jörg H Distler AU - Bernhard Manger AU - Georg Schett AU - Jochen Zwerina Y1 - 2011/04/01 UR - http://ard.bmj.com/content/early/2011/04/24/ard.2010.149351.abstract N2 - 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.Figure 1 PET/CT scans before and after tocilizumab … ER -