Jacobs Journal of Clinical Case Reports

Improvement of Knee Joint and Laboratory Markers of a Rheumatoid Arthritis Patient Treated with Tocilizumab

Published on: 2014-09-01


Here, we report on the case of 27-year-old women with rheumatoid arthritis [RA] whose symptoms improved after the administration of tocilizumab [TCZ] following long-term biological disease-modifying anti-rheumatic drugs treatment. The clinical changes in her signs and symptoms were confirmed by radiographic analysis of the affected knee joint and laboratory markers including C-reactive protein, matrix metalloproteinase-3, amino-terminal telopeptides of type 1 collagen [NTX], osteocalcin, interleukin-6, anti-cyclic citrullinated peptide, carboxy-terminal telopeptides od type 2 collagen [CTX-2], Dikkopf-1 [DKK-1], and osteoprotegerin [OPG] levels. Changes in disease activity score [DAS] 28-erythrocytes sedimentation rate were also estimated during the clinical physical observation. Initially, she was prescribed bucillamine, methotrexate [MTX] and salazosulfapyridine [SASP], however her RA activity was not improved. Therefore, the prescription was changed to predonisolone, and mizoribine. However, her RA activity was still not controlled and she was referred to our hospital. At our clinic, etenercept and MTX were prescribed, but her RA activity was not controlled. After 1 year, although adalimumab and MTX were prescribed, these agents were not effective in controlling the RA. Finally, TCZ, PD and SASP were prescribed. These medications greatly suppressed her RA activity, which correlated with the improvement of NTX, CTX-2, DKK-1 and OPG levels. Physical changes were also confirmed radiographically, including a widening of the joints space and enlargement of range of motion. Thus, her state of RA was greatly improved by TCZ.


Rheumatoid Arthritis; Joint Space Narrowing; Tocilizumab; Carboxy-Terminal Telopeptides of type 2 collagen; Dickkopf-1; Osteoprotegerin