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Tocilizumab treatment in Felty’s syndrome

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Abstract

Felty’s syndrome (FS) is a deforming disease, characterized by the triad of rheumatoid arthritis (RA), neutropenia, and splenomegaly. Currently, FS patients are treated mainly with immunosuppressants, such as methotrexate and glucocorticoids, which however are not suitable to some patients and may cause severe side effects. Here we report a clinical FS case that was treated with Tocilizumab (TCZ) successfully. The patient had symmetrical swelling and pain of multiple joints, deformity of elbow joints with obvious morning stiffness. Joint color Doppler ultrasound showed synovial hyperplasia and bone erosion of wrist and proximal interphalangeal joints and CT scan suggested splenomegaly. Further examination showed neutropenia and anemia, a high titer of anti-cyclic citrullinated peptide antibody, rheumatoid factor and anti-nuclear antibodies, positive p-ANCA, and elevated IgA and IgG. After treating with TCZ, the patient has been relieved of clinical symptoms. His spleen has recovered to normal size. The absolute neutrophil count (ANC) tended to be stable, and joint erosion did not deteriorate. We have reviewed the literatures on FS treatment with biological agents and found only a few reports using TNF-α antagonist and rituximab treating FS, but none with TCZ. So, it is the first time to report a successful FS case treated with TCZ. This case suggests that the TCZ may be a new choice for FS treatment, under the condition of closely monitoring the ANC.

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Acknowledgements

The authors would like to thank the editors and two reviewers for great assistance with their paper revision. A very special thanks to Dr. Jianying Shen for her hardwork in language editing of this manuscript.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Rheumatology and Immunology, Jingzhou Central Hospital, Jingzhou Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Jingzhou, 434000, China

    Rongda Li, Qi Wan, Pan Chen, Shufen Mao, Qiuju Wang, Xiaoxin Li, Yi Yang & Li Dong

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  1. Rongda Li
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  3. Pan Chen
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Correspondence to Li Dong.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. All authors fulfilled the ICMJE authorship criteria.

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Informed consent was obtained from the individual participant included in the study. Informed consent was obtained from this patient for publication of this case report and any accompanying images. A copy of this consent is available to the editors of the journal.

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Li, R., Wan, Q., Chen, P. et al. Tocilizumab treatment in Felty’s syndrome. Rheumatol Int 40, 1143–1149 (2020). https://doi.org/10.1007/s00296-020-04588-3

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