Add-on Clarithromycin and Tacrolimus Treatment for Rheumatoid Arthritis

  • Masashi Ohe JCHO Hokkaido Hospital
  • Ken Furuya JCHO Hokkaido Hospital
Keywords: Rheumatoid arthritis, clarithromycin, tacrolimus

Abstract

A 67-year-old woman suffering from rheumatoid arthritis (RA) presented with gradual exacerbation of arthralgia and/or articular swellings. She was diagnosed with RA at 62 years of age and successfully treated using methotrexate (MTX) in combination with loxonin (LOX). Three months after this treatment, cytopenia occurred as a side effect of MTX; therefore, MTX was stopped. Thereafter, RA had been largely controlled using salazosulfapyridine in combination with prednisolone and LOX for almost 4 years. On this visit, because RA became worse, clarithromycin (CAM) was added in expectation of its anti-inflammatory effects on RA. CAM treatment was effective for RA, to a certain extent; however, the RA activity was not sufficiently suppressed. In order to suppress the RA activity further, tacrolimus (TAC), an armament in the treatment for active RA in Japan, was added. Three months after initiating TAC treatment, the RA activity was considerably suppressed. This case shows that physicians should consider add-on CAM and TAC treatment when existing ant-rheumatic agents show little effects on RA.

References

Ogrendik M. Effects of clarithromycin in patients with active rheumatoid arthritis. Curr Med Res Opin 2007;23: 515-22.

Ohe M. Add-on clarithromycin and tacrolimus treatment for rheumatoid arthritis. J Rheum Dis 2017;24:123-4.

Inoue E, Yamanaka H, Hara M, Tomomatsu T, Kamatani N. Comparison of Disease Activity Score (DAS)28-erythrocyte sedimentation rate and DAS28-C-reactive protein threshold values. Ann Rheum Dis 2007;66:407-9.

Tamaoki J, Kadota J, Takizawa H. Clinical implications of the immunomodulatory effects of macrolides. Am J Med 2004;117 (Suppl 9A):S5-11.

Magari K, Miyata S, Nishigaki F, Ohkubo Y, Mutoh S, Goto T. Differential effects of FK506 and methotrexate on inflammatory cytokine levels in rat adjuvant-induced arthritis. J Rheumatol 2003;30:2193-2200.

Published
2018-09-22