Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2023; 11(11): 2474-2481
Published online Apr 16, 2023. doi: 10.12998/wjcc.v11.i11.2474
Difficult-to-treat rheumatoid arthritis treated with Abatacept combined with Baricitinib: A case report
Jia-Ping Qi, Huan Jiang, Teng Wu, Yuan Zhang, Wei Huang, Yi-Xuan Li, Jing Wang, Ju Zhang, Zhen-Hua Ying
Jia-Ping Qi, Yuan Zhang, Zhen-Hua Ying, Graduate School, Bengbu Medical College, Bengbu 233030, Anhui Province, China
Jia-Ping Qi, Huan Jiang, Teng Wu, Yuan Zhang, Wei Huang, Yi-Xuan Li, Jing Wang, Ju Zhang, Zhen-Hua Ying, Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou 310000, Zhejiang Province, China
Jia-Ping Qi, Huan Jiang, Teng Wu, Yuan Zhang, Wei Huang, Yi-Xuan Li, Jing Wang, Ju Zhang, Zhen-Hua Ying, Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China
Huan Jiang, Teng Wu, Yi-Xuan Li, Jing Wang, Zhen-Hua Ying, The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
Author contributions: Qi JP contributed to the intellectual content and drafted the manuscript; Jiang H and Wu T were responsible for the acquisition and interpretation of the data; Huang W and Li YX reconstructed the images, prepared the legends, and updated the literature; Wang J and Zhang J reviewed the data and interpreted the results; Zhang Y was responsible for the acquisition of Color Doppler flow imaging; All authors made a substantial contribution to the preparation of the manuscript, as well as read and approved the final version of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen-Hua Ying, MM, Chief Doctor, Professor, Teacher, Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, No. 158 Shangtang Road, Hangzhou 310000, Zhejiang Province, China. yingzh2021@163.com
Received: October 20, 2022
Peer-review started: October 20, 2022
First decision: February 7, 2023
Revised: February 19, 2023
Accepted: March 20, 2023
Article in press: March 20, 2023
Published online: April 16, 2023
Processing time: 168 Days and 1.3 Hours
Abstract
BACKGROUND

Sporadic cases of rheumatoid arthritis (RA) due to unsatisfactory responses to Abatacept (ABT) have been reported; however, the rescue therapy has not been finalized. Here, we present a case with difficult-to-treat RA (D2T RA) that was resistant to either a single ABT or a Janus kinase (JAK) inhibitor (Tofacitinib), but improved with a combination of ABT and JAK inhibitor (Baricitinib, BAT).

CASE SUMMARY

A 46-year-old Chinese woman who had RA for ten years that was resistant to Tocilizumab, Etanercept, Adalimumab, and ABT. According to the European League Against Rheumatism definition, the patient was diagnosed with D2T RA. It was then improved with a combination of ABT and a JAK inhibitor BAT.

CONCLUSION

ABT combined with BAT may be an acceptable strategy for treating D2T RA.

Keywords: Difficult-to-treat rheumatoid arthritis; Abatacept; Baricitinib; Combination therapy; Case report

Core Tip: Although the combined use of Abatacept (ABT) and Janus kinase (JAK) inhibitors is not recommended in rheumatoid arthritis (RA) treatment guidelines, inflammatory cytokines have been found to compensate for the inhibitory effect of ABT on co-stimulatory signals, activate T-lymphocytes through the JAK/ Signal Transducers and Activators of Transcription pathway, and promote the inflammatory response. In the treatment of this patient, Baricitinib, as a JAK inhibitor, combined with ABT can be used as a rescue treatment for difficult-to-treat RA, especially for patients with poor responses to single ABT treatment.