Positive effects of tocilizumab in late-stage rheumatoid arthritis (clinical case)

Treatment of late-stage rheumatoid arthritis (RA) in elderly patients presents known difficulties, which are associated with insufficient control of inflammation, the addition of extra-articular manifestations of the disease, the development of its complications, the presence of comorbidity, frequent intolerance to basic drugs and the potential toxicity of symptomatic agents. A clinical case of an elderly patient with a 20-year history of RA is presented. The disease was characterized by a progressive course, the ineffectiveness of synthetic basic anti-inflammatory drugs, the development of extra-articular manifestations (Sjogren's syndrome, anemia of chronic inflammation), secondary arthrosis of the joints of the lower extremities, osteoporosis with compression fractures of the vertebral bodies, probable AA-amyloidosis of the kidneys with chronic kidney disease, sarcopenia. The comorbid background included type 2 diabetes mellitus, arterial hypertension, ischemic stroke, non-alcoholic fatty liver disease, and dyslipidemia. After careful screening, tocilizumab therapy was initiated in subcutaneous form of 162 mg weekly. After 4 weeks, there was a decrease in morning stiffness, a decrease in the number of painful and swollen joints. By the 12^th week, relief of synovitis, normalization of C-reactive protein levels and erythrocyte sedimentation rate, increased hemoglobin, decreased proteinuria, and stabilization of kidney function were recorded. The DAS28 index dropped from 7.1 to 2.6. Prednisone was completely eliminated by week 20. Currently, tocilizumab therapy lasts 7 months, the drug is well tolerated, and no infectious complications, cytopenic or other adverse reactions have been reported. The use of a tocilizumab biosimilar in an elderly patient with long-term severe RA, multiple complications and comorbidity made it possible to achieve clinical and laboratory remission, stop anemia of chronic inflammation, reduce proteinuria, eliminate glucocorticoids and significantly improve the quality of life. The presented case substantiates the expediency of using IL-6 receptor inhibitors (including subcutaneous biosimilars) in patients of the older age group with a complicated course of RA.

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