Efficacy of tocilizumab in a patient with refractory psoriatic arthritis.

Psoriatic arthritis (PsA) is an inflammatory arthropathy, associated with skin and/or nail psoriasis and other possible systemic features. In the last years, PsA therapy has been revolutionized by the increasing knowledge in the pathogenetic mechanisms of the disease, involving dysfunction and oversecretion of multiple proinflammatory molecules, in particular tumor necrosis factor (TNF)-α. Hence, therapy of PsA refractory to disease-modifying antirheumatic drugs (DMARDs) relies mainly on the use of anti-TNF-α agents. However, since PsA can often be refractory also to these therapies, use of agents acting on other cytokines, such as interleukin (IL)-1 receptor targeted by anakinra, the IL-12/23 receptor by ustekinumab, the IL-17A by secukinumab, and the IL-6 receptor by tocilizumab, has been reported successfully. Herein we report a case of a refractory PsA patient successfully treated with the IL-6 receptor agent, tocilizumab. A review of the literature on the use of tocilizumab in PsA has been performed.