{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:40:12Z","timestamp":1792600812923,"version":"4.5.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Cerebral arteritis is a rare (&amp;lt;1%) but life-threatening manifestation of systemic lupus erythematosus (SLE). The optimal treatment for cerebral arteritis in refractory cases remains unclear; conventional immunosuppressive therapy results in an improvement in arterial stenosis in only 29% of reported cases. We report the case of a 51-year-old woman with a 20-year history of SLE and rheumatoid arthritis who developed aphasia and right hemiparesis due to a haemodynamic cerebral infarction caused by cerebral arteritis. Despite treatment with high-dose glucocorticoids, intravenous cyclophosphamide, mycophenolate mofetil, and anifrolumab, the disease remained progressive with persistently elevated C-reactive protein levels and worsening arterial stenosis on magnetic resonance angiography. Cerebrospinal fluid interleukin-6 level was markedly elevated (1590\u00a0pg\/ml). After switching from anifrolumab to tocilizumab, C-reactive protein levels normalised, the patient\u2019s neurological condition stabilised, and follow-up magnetic resonance angiography suggested an improvement in arterial stenosis. Tocilizumab might be a viable treatment option for refractory cerebral arteritis in patients with SLE, particularly in cases with elevated cerebrospinal fluid interleukin-6 levels. To our knowledge, this is the first reported case suggesting the potential efficacy of tocilizumab in SLE-related cerebral arteritis.<\/jats:p>","DOI":"10.1093\/mrcr\/rxag094","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:58:07Z","timestamp":1790769487000},"source":"Crossref","is-referenced-by-count":0,"title":["Tocilizumab for refractory cerebral arteritis in a patient with systemic lupus erythematosus"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8601-8296","authenticated-orcid":false,"given":"Yasuto","family":"Minegishi","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University (Ohashi Medical Center) , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4173-0651","authenticated-orcid":false,"given":"Takehisa","family":"Ogura","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University (Ohashi Medical Center) , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2114-9190","authenticated-orcid":false,"given":"Chihiro","family":"Imaizumi","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University (Ohashi Medical Center) , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7168-1501","authenticated-orcid":false,"given":"Reina","family":"Maezawa","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University (Ohashi Medical Center) , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takafumi","family":"Uchi","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Toho University (Ohashi Medical Center) , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4330-5782","authenticated-orcid":false,"given":"Hideto","family":"Kameda","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University (Ohashi Medical Center) , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"2026102111513660500_ref1","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.jaut.2016.06.013","article-title":"The diagnosis and clinical management of the neuropsychiatric manifestations of lupus","volume":"74","author":"Govoni","year":"2016","journal-title":"J Autoimmun"},{"key":"2026102111513660500_ref2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.semarthrit.2010.08.001","article-title":"Neuropsychiatric syndromes in systemic lupus erythematosus: a meta-analysis","volume":"41","author":"Unterman","year":"2011","journal-title":"Semin Arthritis Rheum"},{"key":"2026102111513660500_ref3","doi-asserted-by":"publisher","first-page":"7","DOI":"10.31138\/mjr.30.1.7","article-title":"Cerebrovascular events in systemic lupus erythematosus: diagnosis and management","volume":"30","author":"Nikolopoulos","year":"2019","journal-title":"Mediterr J Rheumatol"},{"key":"2026102111513660500_ref4","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1161\/01.STR.20.5.583","article-title":"Frequency, etiology, and prevention of stroke in patients with systemic lupus erythematosus","volume":"20","author":"Futrell","year":"1989","journal-title":"Stroke."},{"key":"2026102111513660500_ref5","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.1177\/0961203314541689","article-title":"Cerebral large vessel vasculitis in systemic lupus erythematosus","volume":"23","author":"B\u00f6ckle","year":"2014","journal-title":"Lupus"},{"key":"2026102111513660500_ref6","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1136\/jnnp.2009.187856","article-title":"Reversible cerebral vasoconstriction syndrome","volume":"9","author":"Ducros","year":"2009","journal-title":"Pract Neurol"},{"key":"2026102111513660500_ref7","doi-asserted-by":"publisher","first-page":"34","DOI":"10.7326\/0003-4819-146-1-200701020-00007","article-title":"Narrative review: reversible cerebral vasoconstriction syndromes","volume":"146","author":"Calabrese","year":"2007","journal-title":"Ann Intern Med"},{"key":"2026102111513660500_ref8","doi-asserted-by":"publisher","first-page":"1440","DOI":"10.1177\/0961203317694259","article-title":"Central nervous system vasculitis in systemic lupus erythematosus: a case series report in a tertiary referral Centre","volume":"26","author":"Rodrigues","year":"2017","journal-title":"Lupus"},{"key":"2026102111513660500_ref9","first-page":"1277","article-title":"Sensitivities of noninvasive tests for central nervous system vasculitis: a comparison of lumbar puncture, computed tomography, and magnetic resonance imaging","volume":"21","author":"Stone","year":"1994","journal-title":"J Rheumatol"},{"key":"2026102111513660500_ref10","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1002\/art.1780330506","article-title":"Elevated levels of interleukin-6 in cerebrospinal fluid from patients with systemic lupus erythematosus and central nervous system involvement","volume":"33","author":"Hirohata","year":"1990","journal-title":"Arthritis Rheum"},{"key":"2026102111513660500_ref11","doi-asserted-by":"publisher","first-page":"1242","DOI":"10.1002\/art.22451","article-title":"Interleukin-6 and chemokines in the neuropsychiatric manifestations of systemic lupus erythematosus","volume":"56","author":"Fragoso-Loyo","year":"2007","journal-title":"Arthritis Rheum"},{"key":"2026102111513660500_ref12","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1007\/s10067-009-1226-8","article-title":"Accuracy of cerebrospinal fluid IL-6 testing for diagnosis of lupus psychosis. A multicenter retrospective study","volume":"28","author":"Hirohata","year":"2009","journal-title":"Clin Rheumatol"},{"key":"2026102111513660500_ref13","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1002\/acr2.11217","article-title":"Role of serum IL-6 in neuropsychiatric systemic lupus erythematosus","volume":"3","author":"Hirohata","year":"2021","journal-title":"ACR Open Rheumatol"},{"key":"2026102111513660500_ref14","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1056\/NEJMoa1613849","article-title":"Trial of tocilizumab in giant-cell arteritis","volume":"377","author":"Stone","year":"2017","journal-title":"N Engl J Med"},{"key":"2026102111513660500_ref15","doi-asserted-by":"publisher","first-page":"e000137","DOI":"10.1136\/rmdopen-2015-000137","article-title":"Long-term efficacy and safety of tocilizumab in giant cell arteritis and large vessel vasculitis","volume":"2","author":"Evans","year":"2016","journal-title":"RMD Open"},{"key":"2026102111513660500_ref16","doi-asserted-by":"publisher","first-page":"2427","DOI":"10.1093\/rheumatology\/kez630","article-title":"Long-term efficacy and safety of tocilizumab in refractory Takayasu arteritis: final results of the randomized controlled phase 3 TAKT study","volume":"59","author":"Nakaoka","year":"2020","journal-title":"Rheumatology (Oxford)"},{"key":"2026102111513660500_ref17","doi-asserted-by":"publisher","first-page":"1725","DOI":"10.1002\/art.1780400928","article-title":"Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus","volume":"40","author":"Hochberg","year":"1997","journal-title":"Arthritis Rheum"},{"key":"2026102111513660500_ref18","doi-asserted-by":"publisher","first-page":"1580","DOI":"10.1136\/ard.2010.138461","article-title":"2010 rheumatoid arthritis classification criteria: an American College of Rheumatology\/European League Against Rheumatism collaborative initiative","volume":"69","author":"Aletaha","year":"2010","journal-title":"Ann Rheum Dis"},{"key":"2026102111513660500_ref19","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1016\/j.berh.2019.02.003","article-title":"Central nervous system involvement in rheumatoid arthritis patients and the potential implications of using biological agents","volume":"32","author":"Atzeni","year":"2018","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"2026102111513660500_ref20","doi-asserted-by":"publisher","first-page":"807","DOI":"10.18999\/nagjms.82.4.807","article-title":"A case of systemic lupus erythematosus associated with cerebral arteritis: a case report and case-based literature review","volume":"82","author":"Nishigaichi","year":"2020","journal-title":"Nagoya J Med Sci"},{"key":"2026102111513660500_ref21","doi-asserted-by":"publisher","first-page":"3225","DOI":"10.2169\/internalmedicine.4958-20","article-title":"Isolated cerebral vasculitis in the unilateral middle cerebral artery in a case with SLE","volume":"59","author":"Takeshita","year":"2020","journal-title":"Intern Med"},{"key":"2026102111513660500_ref22","doi-asserted-by":"publisher","first-page":"51","DOI":"10.31728\/jnn.2022.00112","article-title":"Acute stroke caused by large vessel vasculitis in a patient with systemic lupus erythematosus","volume":"14","author":"Lee","year":"2022","journal-title":"J Neurosonol Neuroimag"},{"key":"2026102111513660500_ref23","doi-asserted-by":"publisher","first-page":"78","DOI":"10.31728\/jnn.2022.00125","article-title":"Steroid-responsive cerebral vasculitis in systemic lupus erythematosus with sulcal hyperintensities","volume":"14","author":"Kim","year":"2022","journal-title":"J Neurosonol Neuroimag"},{"key":"2026102111513660500_ref24","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1177\/19418744231182285","article-title":"Clinical problem solving: a 38-year-old woman with systemic lupus erythematosus presenting with headache, nausea, and vomiting","volume":"13","author":"Silverman","year":"2023","journal-title":"Neurohospitalist"},{"key":"2026102111513660500_ref25","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1097\/NRL.0000000000000520","article-title":"A case of cerebral large-vessel vasculitis concomitant Fahr syndrome in systemic lupus erythematosus","volume":"29","author":"Jiang","year":"2024","journal-title":"Neurologist."},{"key":"2026102111513660500_ref26","doi-asserted-by":"publisher","first-page":"e70606","DOI":"10.1002\/ccr3.70606","article-title":"Stroke in the young: a case of CNS vasculitis secondary to systemic lupus erythematosus","volume":"13","author":"Badir","year":"2025","journal-title":"Clin Case Reports"}],"container-title":["Modern Rheumatology Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/mrcr\/advance-article-pdf\/doi\/10.1093\/mrcr\/rxag094\/71519189\/rxag094.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mrcr\/article-pdf\/10\/2\/rxag094\/71519189\/rxag094.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mrcr\/article-pdf\/10\/2\/rxag094\/71519189\/rxag094.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T15:51:43Z","timestamp":1792597903000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/mrcr\/article\/doi\/10.1093\/mrcr\/rxag094\/8853788"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":26,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,6,29]]}},"URL":"https:\/\/doi.org\/10.1093\/mrcr\/rxag094","relation":{},"ISSN":["2472-5625"],"issn-type":[{"value":"2472-5625","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026]]},"published":{"date-parts":[[2026]]},"article-number":"rxag094"}}