Intravenous laser blood irradiation and tocilizumab in a patient with juvenile arthritis.

This study presents effects of intravenous laser blood irradiation (ILBI) in a transient immunodeficiency patient with juvenile idiopathic arthritis (JIA) treated with an interleukin-6 receptor inhibitor (Tocilizumab). Biological agents induce JIA remission, but some patients do not respond favorably to this final therapeutic line of defense. ILBI was performed in a 16-year-old male patient, with JIA and transient immunodeficiency. When ILBI was introduced, the patient was receiving disease-modifying drugs, steroids, tocilizumab, and physical therapy. Because the disease was not well controlled, ILBI was applied in addition to other ongoing therapies. The patient underwent 1 session daily, and 10 successive sessions per month, repeated every 3 months, for 7 months. Patient evaluation was performed before ILBI was started and at 3, 6, 9, and 12 months after ILBI initiation, using the ACR Pediatric response. The outcome was evaluated using Pediatric 50, 70, and 90 responses and compared to initial status, after 3, 6, 9, and 12 months. At the end of study, the titre of IgA and IgG levels returned to normal. Synergistic anti-inflammatory effect of ILBI was evident, if applied additionally in combination with tocilizumab, in a patient with a therapy-resistant severe form of JIA and related subacute transient immunodeficiency.

本研究阐述了静脉激光血液照射（ILBI）对一名使用白细胞介素 - 6受体抑制剂（托珠单抗）治疗的幼年特发性关节炎（JIA）伴短暂性免疫缺陷患者的影响。生物制剂可诱导JIA缓解，但一些患者对这一最终的治疗防线反应不佳。对一名16岁患有JIA和短暂性免疫缺陷的男性患者进行了ILBI治疗。开始ILBI时，患者正在接受病情改善药物、类固醇、托珠单抗和物理治疗。由于病情控制不佳，在其他现有治疗的基础上增加了ILBI治疗。患者每天进行1次治疗，每月连续10次，每3个月重复一次，共进行7个月。在ILBI开始前以及开始后的3、6、9和12个月，使用美国风湿病学会儿科反应标准对患者进行评估。使用儿科50、70和90反应评估治疗结果，并与初始状态以及3、6、9和12个月后的状态进行比较。研究结束时，IgA和IgG水平的滴度恢复正常。对于一名患有对治疗有抵抗的严重JIA及相关亚急性短暂性免疫缺陷的患者，如果在使用托珠单抗的基础上额外联合应用ILBI，其协同抗炎作用明显。