Anaphylaxis to tocilizumab in patients with rheumatic disease

Immunotherapy ◽  
2021 ◽  
Author(s):  
So Hye Nam ◽  
Doo-Ho Lim ◽  
Hyun Mi Heo ◽  
Ji Seon Oh ◽  
Hyouk-Soo Kwon ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Retrospective Study ◽  
Rheumatic Disease ◽  
Takayasu Arteritis ◽  
Adult Onset Still’S Disease ◽  
Still’S Disease ◽  
Intensive Monitoring ◽  
The Third ◽  
Adult Onset Still's Disease

Background: Anaphylaxis to tocilizumab has been reported anecdotally. Therefore, we evaluated the incidence of anaphylaxis in patients starting tocilizumab. Materials & methods: This retrospective study included patients with rheumatic disease who were administered tocilizumab from 2013 to 2020. The incidence of anaphylaxis was examined during the first 6 months. Results: During follow-up, four of 171 patients developed anaphylaxis within the third course of infusions. The incidence of anaphylaxis to tocilizumab was higher in patients with adult-onset Still’s disease (AOSD) than in those with other rheumatic disease (21.4% in AOSD vs 0.7% in rheumatoid arthritis vs 0% in Takayasu arteritis). Conclusions: When we consider tocilizumab treatment, especially in AOSD, we should keep in mind that intensive monitoring for anaphylaxis is necessary.

scholarly journals Clinical phenotypes and prognostic factors of adult-onset Still’s disease: data from a large inpatient cohort

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Rui Li ◽  
Xiaolei Liu ◽  
Guangliang Chen ◽  
Guo Tang ◽  
Xiaoxiang Chen ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Infection Rate ◽  
Age At Onset ◽  
Clinical Manifestations ◽  
Adult Onset Still’S Disease ◽  
Still’S Disease ◽  
Clinical Phenotypes ◽  
Cluster 2 ◽  
Adult Onset Still's Disease

Abstract Objectives To define different clinical phenotypes and assess prognostic factors of adult-onset Still’s disease (AOSD). Methods Overall, 492 patients with AOSD seen between 2004 and 2018 at a single centre were retrospectively studied. Results Of these patients, 78% were female, and the median age at onset was 34 (25–49) years [median (25th–75th percentile)]. The median follow-up time was 7 (3–10) years [median (25th–75th percentile)]. Clinical manifestations at admission were used to subdivide patients with AOSD as follows: systemic inflammation (cluster 1), pure (cluster 2), and intermediate (cluster 3). Each subtype had distinct clinical manifestations and prognoses: cluster 1 (34.6%)—multiple organ manifestations, highest infection rate and mortality, and more than half of the patients with at least one relapse during follow-up; cluster 2 (21.3%)—exclusively female, rash and joint involvement, no internal organ involvement, no mortality, and most of the patients with a monocyclic course; and cluster 3 (44.1%)—less infection rate, no serious complications, and lower mortality rate. The 5- and 10-year survival rates after diagnosis were 92.4% and 86.9%, respectively. Independent risk factors for mortality were age at onset ≥50 (hazard ratio (HR): 6.78, 95% CI: 2.10–21.89), hepatomegaly (HR: 5.05, 95% CI: 1.44–17.70), infection (HR: 15.56, 95% CI: 5.88–41.20), and MAS (HR: 26.82, 95% CI: 7.52–95.60). Conclusion Three subtypes of AOSD were identified with distinct clinical manifestations and prognoses. Age at onset ≥50, hepatomegaly, infection, and MAS were prognostic factors for AOSD mortality.

scholarly journals Expand the differential…think beyond rheumatoid arthritis

2018 ◽  
pp. bcr-2018-225618 ◽  
Author(s):  
Cody Schwartz ◽  
Altelisha Taylor ◽  
Zareen Zaidi
Keyword(s):  
Rheumatoid Arthritis ◽  
Signs And Symptoms ◽  
Adult Onset Still’S Disease ◽  
Adult Onset ◽  
Still’S Disease ◽  
Rapid Improvement ◽  
Academic Medical Centre ◽  
Still's Disease ◽  
Yamaguchi Criteria ◽  
Adult Onset Still's Disease

A 31-year-old male patient with severe, migratory arthralgias presented to our academic medical centre after being erroneously diagnosed and treated for rheumatoid arthritis for over 1 year. Multiple immunomodulatory therapies for rheumatoid arthritis were attempted with no relief of symptoms. Eventually, the pain was so bothersome that the patient became bedridden for 1 month prior to presenting to our facility. Our assessment revealed that the patient met the diagnostic criteria, known as the Yamaguchi criteria, needed to diagnose adult-onset Still’s disease. Yamaguchi criteria include migratory inflammatory arthritis, quotidian fevers, leucocytosis and a salmon-coloured maculopapular rash. These signs and symptoms may go unnoticed or overlooked if adult-onset Still’s disease is not considered. The patient was treated with anakinra (a recombinant human IL-1 receptor antagonist) and had rapid improvement in his symptoms, with the restoration of mobility.

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