Successful Use of Tocilizumab in a Patient withCoexisting Rheumatoid Arthritis and Ulcerative Colitis

Tocilizumab is an interleukin-6 receptor inhibitor licensed for moderate to severe rheumatoid arthritis (RA). We report a case ofTocilizumab monotherapy for severe active RA in a patient with coexisting ulcerative colitis (UC). The patient was intolerant tomultiple disease-modifying drugs, so Tocilizumab monotherapy was commenced. We found clinical improvement in both RAand UC. There was no major adverse event after 2 years. Manufacturer advised caution in using Tocilizumab in patient withgastrointestinal ulceration due to an increased risk of bowel perforation. However, alternative treatments such as glucocorticoidand nonsteroidal anti-inflammatory drugs may carry a higher bowel perforation risk. The presence of gastrointestinal ulcerationtherefore should not constitute an absolute contraindication for Tocilizumab therapy. Future studies of registry data will informclinician of the Tocilizumab-related risk of gastrointestinal toxicity in “real-life” settings. Contrary to previous case report, we foundTocilizumab therapy to have a positive effect on UC. Laboratory studies supported a role for interleukin-6 in the pathophysiologyof UC. Further clinical trial to evaluate the therapeutic role of Tocilizumab in UC would be warranted