Effective Treatment with Tocilizumab in a Rheumatoid Arthritis Patient Complicated with Human T-cell Leukemia Virus Type 1-associated Myelopathy

Abstract

A 61-year-old woman with human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy (HAM)/ tropical spastic paraparesis (TSP) and interstitial pneumonia (IP) was admitted to our hospital. She complained of sicca symptoms, polyarthralgia, and swollen joints. She was diagnosed with rheumatoid arthritis (RA) and Sjogren's syndrome. Methotrexate and anti-tumor necrosis factor therapy were not utilized because of the inclusion of severe respiratory disorders among the complications and the neurological symptoms of HAM/TSP. Tocilizumab monotherapy improved the RA disease activity without exacerbating HAM/TSP. The present case suggests that tocilizumab might be a suitable treatment option in patients with RA and HAM/ TSP.

Effect of HTLV-1 Infection on the Clinical Course of Patients with Rheumatoid Arthritis

“…Indeed, worsening symptoms of both HAM/TSP and HTLV-1-associated uveitis were reported in an HTLV-1-positive patient with RA who received treatment with a soluble IL-6 receptor inhibitor (sIL-6Ri) [ 89 ]. Conversely, a case report indicated that treatment with sIL-6Ri improved the disease activity of RA patients with HAM/TSP without a flare of neurologic manifestations [ 90 ]. Given the difference in clinical outcomes between these cases, it remains unclear whether sIL-6Ri is safe for RA patients with HAM/TSP.…”