---
title: "Tocilizumab Use in Rheumatoid Arthritis with Concomitant Primary Biliary Cholangitis: Case-Based R"
id: "pubmed-42888283"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42888283"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42888283/"
doi: "10.1007/s00296-026-06303-0"
published_at: "2026-10-17T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Tocilizumab Use in Rheumatoid Arthritis with Concomitant Primary Biliary Cholangitis: Case-Based R
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42888283
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42888283/)
- **DOI:** [10.1007/s00296-026-06303-0](https://doi.org/10.1007%2Fs00296-026-06303-0)
- **Published At:** 2026-10-17T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- A single-patient case report described a 59-year-old woman with highly active, seropositive **rheumatoid arthritis** and biochemical cholestasis who was diagnosed with active **primary biliary cholangitis** without advanced fibrosis. - The treating team avoided methotrexate and leflunomide because of ongoing cholestatic liver disease; the report did not specify exact dosing regimens for any drugs. - The patient started subcutaneous **tocilizumab** alongside **ursodeoxycholic acid** and **fenofibrate**; the source stated that these concomitant therapies were used but did not detail duration or doses. - Investigators reported progressive improvement in joint inflammation and sustained improvement in cholestatic liver blood tests while on tocilizumab, with no hepatic adverse effects observed in this patient. - The authors performed a focused literature review and identified only two directly relevant case reports, both reporting favorable rheumatologic and hepatic outcomes during tocilizumab therapy. - The article emphasized the limited evidence base for guiding therapy when active rheumatoid arthritis and active primary biliary cholangitis coexist and framed tocilizumab as a potential option for selected patients. - Ethical considerations: written patient consent obtained; local institutional rules deemed formal ethical approval unnecessary; authors declared no conflicts of interest. - Key limitations: single-patient observation, absence of long-term safety or comparative data, and sparse published experience—questions remain about generalisability and optimal monitoring strategies.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, University Hospital Dubrava, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia. gsukara@gmail.com. * 2 Department of Gastroenterology, Hepatology and Clinical Nutrition, Department of Internal Medicine, University Hospital Dubrava, Zagreb, Croatia. * 3 Department of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, University Hospital Dubrava, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia. * 4 University of Zagreb School of Medicine, Zagreb, Croatia. * 5 Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia. * PMID: **42888283** * DOI: [ 10.1007/s00296-026-06303-0 ](https://doi.org/10.1007/s00296-026-06303-0) Item in Clipboard Review # Tocilizumab for active rheumatoid arthritis in a patient with concomitant primary biliary cholangitis: a case based review Goran Šukara et al. Rheumatol Int. 2026. Show details Display options Display options Format Abstract PubMed PMID Rheumatol Int Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Rheumatol+Int%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Rheumatol+Int%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42888283/) . 2026 Oct 17;46(11):292. doi: 10.1007/s00296-026-06303-0. ### Authors [Goran Šukara](https://pubmed.ncbi.nlm.nih.gov/?term=%C5%A0ukara+G&cauthor_id=42888283)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42888283/#short-view-affiliation-1 "Department of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, University Hospital Dubrava, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia. gsukara@gmail.com."), [Petra Dinjar Kujundžić](https://pubmed.ncbi.nlm.nih.gov/?term=Dinjar+Kujund%C5%BEi%C4%87+P&cauthor_id=42888283)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42888283/#short-view-affiliation-2 "Department of Gastroenterology, Hepatology and Clinical Nutrition, Department of Internal Medicine, University Hospital Dubrava, Zagreb, Croatia."), [Anita Madir](https://pubmed.ncbi.nlm.nih.gov/?term=Madir+A&cauthor_id=42888283)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42888283/#short-view-affiliation-2 "Department of Gastroenterology, Hepatology and Clinical Nutrition, Department of Internal Medicine, University Hospital Dubrava, Zagreb, Croatia."), [Ivana Piteša Košutić](https://pubmed.ncbi.nlm.nih.gov/?term=Pite%C5%A1a+Ko%C5%A1uti%C4%87+I&cauthor_id=42888283)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42888283/#short-view-affiliation-3 "Department of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, University Hospital Dubrava, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia."), [Joško Mitrović](https://pubmed.ncbi.nlm.nih.gov/?term=Mitrovi%C4%87+J&cauthor_id=42888283)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42888283/#short-view-affiliation-3 "Department of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, University Hospital Dubrava, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42888283/#short-view-affiliation-4 "University of Zagreb School of Medicine, Zagreb, Croatia.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42888283/#short-view-affiliation-5 "Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia.") ### Affiliations * 1 Department of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, University Hospital Dubrava, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia. gsukara@gmail.com. * 2 Department of Gastroenterology, Hepatology and Clinical Nutrition, Department of Internal Medicine, University Hospital Dubrava, Zagreb, Croatia. * 3 Department of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, University Hospital Dubrava, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia. * 4 University of Zagreb School of Medicine, Zagreb, Croatia. * 5 Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia. * PMID: **42888283** * DOI: [ 10.1007/s00296-026-06303-0 ](https://doi.org/10.1007/s00296-026-06303-0) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract The coexistence of active rheumatoid arthritis and active primary biliary cholangitis represents a distinct therapeutic challenge. Evidence-based guidance for treatment selection in this clinical setting remains limited, and published experience with tocilizumab is restricted to isolated case reports. We report a 59-year-old woman with highly active, seropositive rheumatoid arthritis and marked cholestatic biochemical activity, in whom diagnostic evaluation revealed active primary biliary cholangitis in the absence of advanced liver fibrosis. Following multidisciplinary assessment, methotrexate and leflunomide were avoided because of active cholestatic liver disease, and treatment with subcutaneous tocilizumab was initiated in combination with ursodeoxycholic acid and fenofibrate. Tocilizumab was well tolerated and led to a progressive improvement in arthritis. In parallel, cholestatic liver parameters showed sustained improvement in the absence of hepatic adverse effects. To contextualize this observation, we performed a focused literature review and identified only two directly relevant case reports, both reporting favorable rheumatologic and hepatic outcomes during tocilizumab therapy. This case adds to the limited body of evidence suggesting that tocilizumab may represent a feasible therapeutic option for selected patients with active rheumatoid arthritis and concomitant primary biliary cholangitis. **Keywords:** Arthritis, Rheumatoid; Cholestasis; Primary biliary cholangitis; Receptors, Interleukin-6; Tocilizumab. © 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Conflict of interest: None. Ethical approval: Ethical approval was not required for this single-patient case report according to local institutional requirements. The report was prepared in accordance with the CARE guidelines and the principles of the Declaration of Helsinki. Patient consent: Written informed consent for publication of this case report and the accompanying clinical data was obtained from the patient. Related congress abstract publication: This work has not previously been presented or published as a congress abstract. Disclaimer: No part of this case-based review has been copied from or published elsewhere. The scientific and clinical content, patient data, analyses, interpretations, and conclusions were generated by the authors and not by artificial intelligence. As stated in the Ethical AI Use disclosure, AI assistance was limited to language and editorial refinement, graph editing, and manuscript-structure review. All AI-assisted output was critically reviewed, verified, and approved by the authors. Ethical AI use: During manuscript preparation, the authors used OpenAI Codex (GPT-5; OpenAI) on July 31, August 1, September 3 and September 6 2026 for language editing, editorial refinement, manuscript structure review, and assistance with graph and table formatting and visual refinement without alteration of the underlying data. All AI-assisted output was critically reviewed and edited by the authors. The authors independently verified the scientific content, references, clinical data, and interpretations and approved the final manuscript. No AI tool was used to generate patient data, perform analyses, or independently formulate clinical conclusions. The authors take full responsibility for the accuracy and integrity of the final manuscript. External editing support: No external commercial editing agency or professional editing agent was involved in the preparation or revision of this manuscript. ## References 1. 1. Smolen JS, Edwards CJ, Konzett V et al (2026) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biologic disease-modifying antirheumatic drugs: 2025 update. Ann Rheum Dis 85:991–1009. - [DOI](https://doi.org/10.1016/j.ard.2026.01.023) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/41826212/) 2. 1. Lindor KD, Bowlus CL, Boyer J, Levy C, Mayo M (2022) Primary biliary cholangitis: 2021 practice guidance update from the American Association for the Study of Liver Diseases. Hepatology 75:1012–1013. - [DOI](https://doi.org/10.1002/hep.32117) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/34431119/) 3. 1. Tanaka A, Ma X, Takahashi A, Vierling JM (2024) Primary biliary cholangitis. Lancet 404:1053–1066. - [DOI](https://doi.org/10.1016/s0140-6736\(24\)01303-5) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/39216494/) 4. 1. Mihai IR, Rezus C, Burlui MA, Cardoneanu A, Macovei LA, Richter P, Bratoiu I, Rezus E (2024) Autoimmune liver diseases and rheumatoid arthritis—is there an etiopathogenic link? Int J Mol Sci 25:3848. - [DOI](https://doi.org/10.3390/ijms25073848) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/38612658/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/11011907/) 5. 1. Smyk DS, Bogdanos DP, Mytilinaiou MG, Burroughs AK, Rigopoulou EI (2012) Rheumatoid arthritis and primary biliary cirrhosis: cause, consequence, or coincidence? Arthritis (Basel). - [DOI](https://doi.org/10.1155/2012/391567) Show all 25 references ## Publication types * Case Reports Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Case+Reports%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Case+Reports) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42888283/) * Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42888283/) ## MeSH terms * Antibodies, Monoclonal, Humanized* / therapeutic use Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Antibodies%2C+Monoclonal%2C+Humanized%2Ftherapeutic+use%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Antibodies%2C+Monoclonal%2C+Humanized) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42888283/) * Antirheumatic Agents* / therapeutic use Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Antirheumatic+Agents%2Ftherapeutic+use%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Antirheumatic+Agents) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42888283/) * Arthritis, Rheumatoid* / complications Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Arthritis%2C+Rheumatoid%2Fcomplications%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Arthritis%2C+Rheumatoid) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42888283/) * Arthritis, Rheumatoid* / diagnosis Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Arthritis%2C+Rheumatoid%2Fdiagnosis%22%5BMAJR%5D&sort=date
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