Add-on Clarithromycin and Tacrolimus Treatment for Rheumatoid Arthritis

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.