A case of rheumatoid pericarditis associated with a high IL-6 titer in the pericardial fluid and tocilizumab treatment.

We report a 60-year-old woman with rheumatoid arthritis complicated by pericarditis. Treatment with tocilizumab improved her polyarthritis, but the pericardial effusion increased so rapidly as to cause cardiac tamponade before the treatment could prove its efficacy. Pericardial effusion disappeared after pericardiocentesis. The pericardial fluid contained a remarkably high concentration of interleukin-6 (IL-6; 351,000 pg/mL), which tocilizumab appeared to have made yet higher compared to the reported IL-6 levels in rheumatoid pericarditis. No further exacerbation of pericarditis was observed after retreatment with tocilizumab. This case has important implications in that it suggests that the prominently elevated IL-6 level in pericardial fluid during tocilizumab treatment may be an indicator of its efficacy for pericarditis.

[Two cases of systemic lupus erythematosus accompanied by antiphospholipid syndrome nephropathy without immune complex nephritis].

We report here two interesting cases of systemic lupus erythematosus(SLE) accompanied by antiphospholipid syndrome nephropathy(APSN). These cases satisfied the criteria for SLE established by the American College of Rheumatology 1997 and also satisfied the criteria for antiphospholipid syndrome (APS) established by the Sapporo International Workshop of APS 1998. Both cases had high blood pressure with elevated plasma renin activity, proteinuria and renal dysfunction. Their biopsied renal specimens showed the characteristic findings for APSN, such as mesangial proliferation, double contours, thickening of the capillary loops, and intimal hyperplasia, but there was no evidence for immune complexes in the glomeruli, which were examined by the indirect immunofluorescence methods and the electron microscopy method. These results indicated that their renal dysfunction was caused by APSN, but not by immune complex nephritis. In addition to treatment with prednisolone, they were administered anticoagulants(warfarin, or aspirin, or heparin) for APSN and an angiotensin II receptor blocker, candesartan, for the hypertension. Subsequently, their conditions recovered with the improvement of renal function and hypertension. Our experiences suggest that anticoagulant therapy in addition to corticosteroids offers advantages in the treatment of patients with SLE accompanied by APSN and renal dysfunction.

[A case of psoriatic arthropathy complicated with HTLV-I carrier and secondary amyloidosis].

We report a case of psoriatic arthropathy complicated with HTLV-I carrier and secondary amyloidosis. She was a 45-year-old woman and was diagnosed as psoriatic arthropathy and HTLV-I carrier in December 1999. She was treated with combination therapy corticosteroid, salazosulfapyridine, methotrexate, cyclophosphamide, and gold sodium. However, her arthralgia and fever was not completely improved. In April in 2001, she was admitted to our hospital because of nausea, vomiting, and diarrhea. Her colon fiberscopic examination showed rubber, erosion, and multiple ulcers of the rectum through descending colon mucosa. Her biopsied specimens of the colon mucosa showed Congo Red dye stained amyloid deposits. Because the loss of stain for Congo Red dye after exposure to potassium permanganate, the deposits were amyloid A protein. This case is considered as a rare case of psoriatic arthropathy and HTLV-I carrier complicated with secondary amyloidosis in a relatively short period (approximately two years) after onset of psoriatic arthropathy.