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Updated: Sep 15, 2025
Knee Arthrocentesis in Adults
Published on: February 25, 2022
Case Report: Intra-articular injection of tocilizumab for arthritis treatment in chronic graft-vs.-host disease
Mingyu Xie1,2,3, Qin Liu1, Huiting Yuan1
1Department of Pediatric Rheumatology and Immunology, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, Guangdong, China.
Insights
Chronic graft-vs.-host disease (cGVHD) can cause arthritis unresponsive to standard treatments. Intra-articular tocilizumab injections showed promise in a juvenile patient with cGVHD-related arthritis, improving mobility and reducing inflammation.
Area of Science:
- Hematology
- Rheumatology
- Immunology
Background:
- Chronic graft-vs.-host disease (cGVHD) is a significant complication following allogeneic hematopoietic cell transplantation.
- Articular involvement is a common manifestation of cGVHD, often refractory to glucocorticoid therapy.
- Existing treatments for cGVHD-related arthritis have limited efficacy in a substantial proportion of patients.
Observation:
- A male adolescent with acute myeloid leukemia post-transplant developed severe arthritis affecting his knee and elbow joints.
- Conventional immunosuppressive therapies including cyclosporine, ruxolitinib, and methylprednisolone failed to alleviate symptoms.
- Despite initial improvement with intravenous tocilizumab, a COVID-19 infection exacerbated knee joint swelling and immobility.
Findings:
- Intra-articular injections of tocilizumab into the affected knee joints led to sustained clinical improvement.
- Treatment resulted in decreased peripheral blood Interleukin-6 (IL-6) levels.
- The patient regained the ability to walk several hundred meters with minimal exertion after four months of intra-articular therapy.
Implications:
- Intra-articular tocilizumab represents a potential therapeutic strategy for refractory arthritis in chronic graft-vs.-host disease.
- This case highlights the localized efficacy of IL-6 blockade in managing severe cGVHD-related joint complications.
- Further large-scale clinical trials are necessary to validate the safety and effectiveness of this treatment approach.
Background:
Chronic graft-vs.-host disease (cGVHD) is a major complication of allogeneic hematopoietic cell transplantation. It is a leading cause of long-term morbidity, non-relapse mortality, and impaired health-related quality of life. cGVHD is a multifactorial syndrome that can manifest with articular involvement. Approximately 50% of cGVHD survivors do not respond to glucocorticoid therapy used for arthritis. Subsequently, we shall present a case of a juvenile patient with arthritis and cGVHD, who responded well to intra-articular injection of tocilizumab, after bone marrow transplantation.
Case Pressentation:
A male adolescent with acute myeloid leukemia successfully underwent marrow stem cell transplantation. However, he developed arthritis in the elbow and knee joints and had difficulty walking more than 3 months after transplantation. He was administered anti-rejection drugs with cyclosporine, ruxolitinib, and methylprednisolone by his physician, which did not work. He was subsequently treated with intravenous tocilizumab under the supervision of his rheumatologist. Although his clinical symptoms showed remission at early stages, his knee joints were more swollen, and he could not stand after being infected with COVID-19. Both of his knee joints was injected with tocilizumab at 0, 2, 4, 6, 7, 11, and 19 weeks. Interleukin (IL)-6 levels in the peripheral blood continuously decreased. After treatment for 4 months, the patient could walk a few hundred meters with minimal exertion.
Conclusion:
An intra-articular injection of tocilizumab could be a viable treatment option for arthritis; however, large-scale clinical trials are warranted to confirm its efficacy.
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