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- Title
Interleukin-6 blockade improves autonomic dysfunction in rheumatoid arthritis.
- Authors
Syngle, Ashit; Verma, Inderjeet; Krishan, Pawan
- Abstract
Autonomic nervous system (ANS) involvement in rheumatoid arthritis (RA) is well recognised and contributes to arrhythmia and sudden death. However, there is no published study documenting the therapeutic efficacy on autonomic neuropathy (AN) in RA. This is the first reported observation of improvement in AN with interleukin-6 (IL-6) blockade with tocilizumab in RA. We report a case of 61-year old female with seropositive RA with severe disease activity, investigated for autonomic neuropathy. Several non invasive tests were used for accurate evaluation of AN function based on assessment of peripheral sympathetic autonomic function and cardiovascular reflex tests. Cardiovascular autonomic function tests at baseline showed marked abnor malities of parasympathetic cardiovascular reflexes. Tocilizumab 8mg/kg intravenous infusion at weeks 0, 4 and 8 was added to her treatment regimen. After the first dose of tocilizumab there was a rapid improvement with normalization of parasympathetic autonomic activity. IL-6 blockade with tocilizumab seems to have the potential to improve the vagus nerve mediated parasympathetic neuropathy and hence has the potential to restore cholinergic anti-inflammatory pathway.
- Subjects
DYSAUTONOMIA; IMMUNOSUPPRESSIVE agents; ANTI-inflammatory agents; INTERLEUKIN-6 receptors; DIAGNOSIS of autonomic nervous system diseases; PARASYMPATHETIC nervous system; VAGUS nerve; THERAPEUTICS
- Publication
Acta Reumatológica Portuguesa, 2015, Vol 40, Issue 1, p85
- ISSN
0303-464X
- Publication type
Case Study