Tocilizumab improved clinical symptoms of a patient with systemic tophaceous gout who had symmetric polyarthritis and fever: An alternative treatment by blockade of interleukin-6 signaling

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  • Sho Mokuda
    Department of Pathology, Ehime University Proteo-Science Centre and Graduate School of Medicine, Shitsukawa 454, Toon, Ehime, 791–0295 Japan
  • Masamoto Kanno
    Department of Immunology, Graduate School of Medicine, Hiroshima University, Hiroshima, 734–8551, Japan
  • Kiyoshi Takasugi
    Centre for Rheumatic Diseases, Dogo Spa Hospital, Matsuyama, Ehime, 790–0858, Japan
  • Chikara Okumura
    Department of Pathology, Ehime University Proteo-Science Centre and Graduate School of Medicine, Shitsukawa 454, Toon, Ehime, 791–0295 Japan
  • Yuki Ito
    Department of Pathology, Ehime University Proteo-Science Centre and Graduate School of Medicine, Shitsukawa 454, Toon, Ehime, 791–0295 Japan
  • Junya Masumoto
    Department of Pathology, Ehime University Proteo-Science Centre and Graduate School of Medicine, Shitsukawa 454, Toon, Ehime, 791–0295 Japan

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<jats:p> Chronic tophaceous gout is the end stage of gout. We employed a blockade of interleukin-6 signaling therapy by tocilizumab instead of anakinra, an interleukin-1 receptor antagonist, for a 61-year-old Japanese woman diagnosed with tophaceous gout. Laboratory data showed that serum interleukin-6 concentration was elevated. Serum interleukin-1β concentration was under the detectable level, although serum uric acid was elevated due to renal dysfunction. The secretion patterns of interleukin-1β, tumor-necrosis factor-α, interleukin-6, and interleukin-8 from peripheral mononuclear cells isolated from the patient exhibited no remarkable differences compared with those of healthy volunteers. After treatment with the interleukin-6 receptor antagonist tocilizumab, serum interleukin-6 concentration decreased followed by improved clinical symptoms, such as reduced size of the subcutaneous nodules, no fever, and no acute gouty attacks during the treatment. Our case suggests that tocilizumab markedly improves clinical and laboratory manifestations in tophaceous gout with arthritis and fever as well as interleukin-1 blockade therapy. </jats:p>

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