Wu, KY, Purswani, P, Ujhazi, B et al. (10 more authors) (2019) Arthritis in Two Patients With Partial Recombination Activating Gene Deficiency. Frontiers in Pediatrics, 7. 235. ISSN 2296-2360
Abstract
Autoimmunity is becoming an increasingly recognized complication in patients with primary immunodeficiencies (PIDs), including a variety of combined immune deficiencies such as Recombination Activating Gene (RAG) defects. The approach to treating autoimmunity in PID patients is complex, requiring a balance between immunosuppression and susceptibility to infection. Inflammatory arthritis is a feature of immune dysregulation in many PIDs, and the optimal treatment may differ from first line therapies that usually consist of disease-modifying anti rheumatic drugs (DMARDs). An example of mechanism-based therapy of arthritis in PID uses blockade of IL-6 signaling with tocilizumab for patients with STAT 3 gain-of-function (GOF) mutation and augmented IL-6 pathway. Herein, we describe two PID cases with arthritis who were found to have defects in RAG. One patient with refractory inflammatory arthritis experienced remarkable improvement in symptoms with tocilizumab therapy. Arthritis can be a clinical feature of immune dysregulation in RAG deficiency, and tocilizumab therapy has been suggested to have utility in treatment of arthritis in RAG deficiency.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2019 Wu, Purswani, Ujhazi, Csomos, Snezhina, Elissaveta, Stefanov, Sharapova, Ellison, Milojevic, Savic, Sargur and Walter. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
Keywords: | recombination activating gene, RAG deficiency, rheumatoid arthritis, primary immunodeficiency, tocilizumab, refractory arthritis |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) > Inflammatory Arthritis (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 25 Feb 2020 11:45 |
Last Modified: | 25 Feb 2020 11:45 |
Status: | Published |
Publisher: | Frontiers Media |
Identification Number: | 10.3389/fped.2019.00235 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:157409 |