{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T11:14:20Z","timestamp":1771931660119,"version":"3.50.1"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Peripheral neuropathy (PN) is a debilitating extra-articular manifestation of rheumatoid arthritis (RA), frequently driven by chronic inflammation and vasculitis. Its management remains challenging owing to limited evidence and the adverse effects associated with long-term glucocorticoids (GCs) use. We present a 48\u2212year\u2212old woman with 21-year seropositive RA who developed severe, progressive PN manifesting as multifocal asymmetric sensorimotor deficits. Electrophysiology confirmed axonal damage, and cerebrospinal fluid (CSF) showed albuminocytologic dissociation. Previous therapies, including methotrexate, etanercept, and tofacitinib, failed to control neuropathy. During a severe flare with high inflammatory markers, she received intravenous methylprednisolone followed by the interleukin-6 (IL-6) receptor antagonist tocilizumab. Within days, neuropathic symptoms and arthritis improved. After 12 months of monthly tocilizumab, inflammatory markers normalized, and repeat nerve\u2212conduction studies demonstrated significant recovery. This case highlights that tocilizumab, by targeting the IL-6 pathway pivotal to RA-associated vasculitis and systemic inflammation, can induce rapid remission of refractory PN while facilitating glucocorticoid tapering. It supports the use of biologic agents with distinct mechanisms in managing complex extra\u2212articular RA.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1770170","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T07:13:54Z","timestamp":1770880434000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prompt clinical and electrophysiological remission of refractory peripheral neuropathy in long-standing rheumatoid arthritis with tocilizumab: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Hai","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Health Management, People\u2019s Hospital of Longhua","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuexian","family":"Zhong","sequence":"additional","affiliation":[{"name":"Yikangyuan Community Health Center, Bao\u2019an Center Hospital of Shenzhen","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shan","family":"Kuang","sequence":"additional","affiliation":[{"name":"Department of emergency and critical care medicine, Shenzhen Fuyong People\u2019s Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinhui","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, People\u2019s Hospital of Longhua","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linghua","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Health Management, Jiangmen Wuyi Hospital of Chinese Medicine","place":["Jiangmen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, People\u2019s Hospital of Longhua","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e18378","DOI":"10.1002\/adma.202518378","article-title":"Disrupting complement-inflammation positive feedback circuit via oligonucleotide hydrogel microspheres for reversing joint inflammation","author":"Zhang","year":"2025","journal-title":"Adv Mater"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e2409661","DOI":"10.1002\/adma.202409661","article-title":"Microenvironment-activatable probe for precise NIR-II monitoring and synergistic immunotherapy in rheumatoid arthritis","volume":"36","author":"Zhang","year":"2024","journal-title":"Adv Mater"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ard.2025.04.009","article-title":"Spatiotemporal distributions and regional disparities of rheumatoid arthritis in 953 global to local locations, 1980-2040, with deep learning-empowered forecasts and evaluation of interventional policies\u2019 benefits","volume":"84","author":"Jin","year":"2025","journal-title":"Ann Rheum Dis"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1390391","article-title":"Neurologic complications of systemic lupus erythematosus, sj\u00f6gren syndrome, and rheumatoid arthritis","volume":"34","author":"Bhattacharyya","year":"2014","journal-title":"Semin Neurol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s42358-022-00238-3","article-title":"Evaluation of peripheral neuropathy in lower limbs of patients with rheumatoid arthritis and its relation to fall risk","volume":"62","author":"de Ara\u00fajo Pereira","year":"2022","journal-title":"Adv Rheumatol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2025.123523","article-title":"Clinical, neurophysiological, and radiological characteristics of peripheral neuropathy in patients with rheumatoid arthritis: A cross-sectional observational study","volume":"473","author":"Abdelrazek","year":"2025","journal-title":"J Neurol Sci"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1085-9489.2006.00084.x","article-title":"Clinical and electrophysiological evaluation of peripheral neuropathy in rheumatoid arthritis","volume":"11","author":"Albani","year":"2006","journal-title":"J Peripher Nerv Syst"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780381114","article-title":"Peripheral neuropathy with necrotizing vasculitis in rheumatoid arthritis. 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