Tocilizumab as a therapeutic option for rheumatoid arthritis patients with interstitial lung disease: Case report

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory, autoimmune disease with significant extra-articular manifestations in the heart, lungs, and kidneys. It can cause interstitial lung disease (ILD) due to synthetic immunosuppressants and biologic agents. However, there is conflicting evidence about the link between RA and lung conditions, with recent research focusing on lung involvement in RA, specifically interstitial lung disease (ILD).

A 63-year-old female with severe early RA developed subacute ILD despite methotrexate treatment, causing cough, dyspnea, and bilateral basal crackles and was on oxygen at home.

Tocilizumab, a humanized monoclonal antibody targeting the Interleukin 6 (IL-6) receptor, was introduced as a treatment option for RA due to its efficacy and ability to mitigate profibrotic effects without the need for methotrexate. After three months, the patient's clinical state improved significantly, with cough and dyspnea symptoms subsiding and bilateral basal crackles resolved, and over a one-year follow-up, the patient's RA disease activity decreased. She also stopped using oxygen. This indicates tocilizumab is a safe and effective therapy for controlling RA in ILD patients without aggravating pulmonary problems.