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Efficacy of tocilizumab for psychiatric symptoms associated with relapsing polychondritis: the first case report and review of the literature

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Abstract

Relapsing polychondritis (RP) rarely affected the central nervous system (CNS). If the CNS is involved, it can result in psychiatric manifestations. Patients with RP always respond well to glucocorticoids and immunosuppressants. If the therapies fail, biologics can be given, such as tocilizumab, which is a humanized monoclonal antibody against the interleukin-6 receptor (IL-6R). Until now, there have been no randomized clinical trials to test the safety and efficacy of biologics, no reports of RP with psychiatric disorders as initial symptoms, and no reports of tocilizumab used for psychiatric symptoms due to RP. Here, we report a 60-year-old woman with mania, logomania, hallucinations, cognitive disorder, persecutory delusion, and violent tendency as chief complaints. The application of dexamethasone worsened her psychiatric symptoms. After the first infusion of tocilizumab, she achieved complete remission within one week. During the follow-up period, she sustained serological and psychiatric remission. Our case illustrates the safety and efficacy of tocilizumab for psychiatric symptoms of RP.

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References

  1. Rapini RP, Warner NB (2006) Relapsing polychondritis. Clin Dermatol 24(6):482–485. doi:10.1016/j.clindermatol.2006.07.018

    Article  PubMed  Google Scholar 

  2. Zeuner M, Straub RH, Rauh G, Albert ED, Scholmerich J, Lang B (1997) Relapsing polychondritis: clinical and immunogenetic analysis of 62 patients. J Rheumatol 24(1):96–101

    CAS  PubMed  Google Scholar 

  3. Lahmer T, Treiber M, von Werder A, Foerger F, Knopf A, Heemann U, Thuermel K (2010) Relapsing polychondritis: an autoimmune disease with many faces. Autoimmun Rev 9(8):540–546. doi:10.1016/j.autrev.2010.2.016

    Article  CAS  PubMed  Google Scholar 

  4. McAdam LP, O’Hanlan MA, Bluestone R, Pearson CM (1976) Relapsing polychondritis: prospective study of 23 patients and a review of the literature. Medicine (Baltimore) 55(3):193–215

    Article  CAS  Google Scholar 

  5. Yoo JH, Chodosh J, Dana R (2011) Relapsing polychondritis: systemic and ocular manifestations, differential diagnosis, management, and prognosis. Semin Ophthalmol 26(4–5):261–269. doi:10.3109/08820538.2011.588653

    Article  PubMed  Google Scholar 

  6. Herrera I, Mannoni A, Altman RD (2002) Relapsing polychondritis: commentary. Reumatismo 54(4):301–306

    CAS  PubMed  Google Scholar 

  7. Sharma A, Gnanapandithan K, Sharma K, Sharma S (2013) Relapsing polychondritis: a review. Clin Rheumatol 32(11):1575–1583. doi:10.1007/s10067-013-2328-x

    Article  PubMed  Google Scholar 

  8. Letko E, Zafirakis P, Baltatzis S, Voudouri A, Livir-Rallatos C, Foster CS (2002) Relapsing polychondritis: a clinical review. Semin Arthritis Rheum 31(6):384–395

    Article  PubMed  Google Scholar 

  9. Ciriaco M, Ventrice P, Russo G, Scicchitano M, Mazzitello G, Scicchitano F, Russo E (2013) Corticosteroid-related central nervous system side effects. J Pharmacol Pharmacother 4(Suppl 1):S94–S98. doi:10.4103/0976-500X.120975

    PubMed  PubMed Central  Google Scholar 

  10. Wolkowitz OM, Rubinow D, Doran AR, Breier A, Berrettini WH, Kling MA, Pickar D (1990) Prednisone effects on neurochemistry and behavior. Preliminary findings. Arch Gen Psychiatry 47(10):963–968

    Article  CAS  PubMed  Google Scholar 

  11. Wada K, Yamada N, Sato T, Suzuki H, Miki M, Lee Y, Akiyama K, Kuroda S (2001) Corticosteroid-induced psychotic and mood disorders: diagnosis defined by DSM-IV and clinical pictures. Psychosomatics 42(6):461–466. doi:10.1176/appi.psy.42.6.461

    Article  CAS  PubMed  Google Scholar 

  12. Goldsmith DR, Rapaport MH, Miller BJ (2016) A meta-analysis of blood cytokine network alterations in psychiatric patients: comparisons between schizophrenia, bipolar disorder and depression. Mol Psychiatry. doi:10.1038/mp.2016.3

  13. Kawai M, Hagihara K, Hirano T, Shima Y, Kuwahara Y, Arimitsu J, Narazaki M, Ogata A, Kawase I, Kishimoto T, Tanaka T (2009) Sustained response to tocilizumab, anti-interleukin-6 receptor antibody, in two patients with refractory relapsing polychondritis. Rheumatology (Oxford) 48(3):318–319. doi:10.1093/rheumatology/ken468

    Article  CAS  Google Scholar 

  14. Wallace ZS, Stone JH (2013) Refractory relapsing polychondritis treated with serial success with interleukin 6 receptor blockade. J Rheumatol 40(1):100–101. doi:10.3899/jrheum.120381

    Article  PubMed  Google Scholar 

  15. Narshi CB, Allard SA (2012) Sustained response to tocilizumab, anti-IL-6 antibody, following anti-TNF-alpha failure in a patient with relapsing polychondritis complicated by aortitis. Rheumatology 51(5):952–953. doi:10.1093/rheumatology/ker451

    Article  CAS  PubMed  Google Scholar 

  16. Loricera J, Blanco R, Castaneda S, Humbria A, Ortego-Centeno N, Narvaez J, Mata C, Melchor S, Aurrecoechea E, Calvo-Alen J, Lluch P, Moll C, Minguez M, Herrero-Beaumont G, Bravo B, Rubio E, Freire M, Peiro E, Gonzalez-Vela C, Rueda-Gotor J, Pina T, Palmou-Fontana N, Calvo-Rio V, Ortiz-Sanjuan F, Gonzalez-Gay MA (2014) Tocilizumab in refractory aortitis: a study on 16 patients and literature review. Clin Exp Rheumatol 32(2):S79–S89

    PubMed  Google Scholar 

  17. Stael R, Smith V, Wittoek R, Creytens D, Mielants H (2015) Sustained response to tocilizumab in a patient with relapsing polychondritis with aortic involvement: a case based review. Clin Rheumatol 34(1):189–193. doi:10.1007/s10067-014-2670-7

    Article  PubMed  Google Scholar 

  18. Weber E, Gaultier JB, Paul S, Guichard I, Monard E, Cathebras P (2014) Sustained response with tocilizumab in a case of refractory relapsing polychondritis. Rev Med Interne 35(3):196–198. doi:10.1016/j.revmed.2013.02.019

    Article  CAS  PubMed  Google Scholar 

  19. Chana JK, Ahmed AA, Edmonds S (2012) Successful use of tocilizumab in a caucasian patient with relapsing polychondritis complicated by sweets syndrome. Rheumatology 51:153–154

    Google Scholar 

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Authors and Affiliations

  1. Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshedong Road, Erqi District, Zhengzhou, Henan, China

    Lijun Liu, Shengyun Liu, Wenjuan Guan & Lei Zhang

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  1. Lijun Liu
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  2. Shengyun Liu
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  3. Wenjuan Guan
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  4. Lei Zhang
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Correspondence to Shengyun Liu.

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All authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Liu, L., Liu, S., Guan, W. et al. Efficacy of tocilizumab for psychiatric symptoms associated with relapsing polychondritis: the first case report and review of the literature. Rheumatol Int 36, 1185–1189 (2016). https://doi.org/10.1007/s00296-016-3509-0

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  • DOI: https://doi.org/10.1007/s00296-016-3509-0

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