Tocilizumab-induced psoriasis in a patient with rheumatoid arthritis: A case report and literature review

摘要

Tocilizumab (TCZ), an anti-interleukin (IL)-6 receptor antibody, has been approved for patients with rheumatoid arthritis (RA) who show an inadequate response to disease-modifying anti-rheumatic drugs (DMARDs) or tumor necrosis factor antagonist in Taiwan. Elevated levels of IL-6 in the serum and synovial fluid contribute to the chronic inflammation in RA. By binding selectively and competitively to the soluble and membrane-bound IL-6 receptors (IL-6Rs), TCZ reduces disease activity in RA. TCZ is generally safe with tolerable adverse reactions, including upper respiratory tract infection, headache, high blood pressure, and elevation of liver enzymes and total cholesterol levels.[1] Based on its anti-inflammatory effect, TCZ rarely induces skin inflammatory disorders such as psoriasis. However, here, we report a patient with RA who developed a de novo rapidly progressive psoriasis after 4 years of TCZ treatment. Furthermore, we review available literature and discuss potential underlying mechanisms.