PMC9198350_01
Clinical course of a patient with rheumatoid arthritis exhibiting systemic pro-inflammatory cytokine responses. (A) Clinical course. The first vaccination day was defined as Day 0. WBC, white blood cell; CRP, C-reactive protein; MTX, methotrexate; PSL, prednisolone; ETN, etanercept; TCZ, tocilizumab. (B) Serum concentrations of cytokines at the active (Day 53) and remitted (Day 172) phases. Serum concentrations of IL-6, TNF-alpha, IFN-alpha, and IFN-beta at the active and remitted phases are shown. Synovial fluids were obtained at the active phase alone. N.D., not done.
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WBC count; 14,600/muL, normal range; 4,000~9,000) and elevated levels of C-reactive protein (CRP 8.45 mg/dL, normal range; 0~0.60). WBC counts and CRP levels were normal before the second vaccination ( Figure 1A ). MTX (6 mg/day) in combination with subcutaneous injection of tocilizumab (162 mg/week) normalized serum concentration of CRP and WBC count ( Figure 1A ).