The optimism surrounding the [[Interleukin 6]] inhibitor drugs should be tempered with caution, as further research is needed to completely understand its efficacy, side effects, and therapeutic potential
((Johnson J, Wang MY. Interlukin-6 receptor inhibitor tocilizumab: a new
treatment option in rheumatoid arthritis? Neurosurgery. 2008 Aug;63(2):N8. doi:
10.1227/01.NEU.0000335796.72760.EC. PubMed PMID: 18797345.)).


====Case series====
Patients hospitalized in the Osaka Rosai Hospital for acute ischemic [[cerebrovascular disease]] from August 2002 to February 2018 were divided into two groups at February 2010. 

Hashimoto et al., retrospectively identified patients with [[rheumatoid arthritis]] (RA). The incidence of RA, occurrence of acute exacerbation of [[inflammation]] due to causes other than [[synovitis]] preceding [[ischemic cerebrovascular disease]] (iCVD) (non-synovitis AEI), and serum [[C reactive protein]] (CRP) were compared.

In the first and second periods, 23/1203 patients (1.9%) and 22/1094 patients (2.0%) with acute iCVD had RA, respectively. Non-synovitis AEI was significantly less frequent in the second period (5%, n=1) than the first period (35%, n=8) (p <0.05). CRP was significantly lower at iCVD onset in the second period (median and interquartile range: 2.72 [0.89-4.5] vs. 0.34 [0.12-1.19 mg/dl], p<0.01). Excluding 9 patients with non-synovitis AEI, CRP was still lower in the second period (1.21 [0.47-2.72] vs. 0.33 [0.11-0.98 mg/dl], p <0.01). CRP levels before both iCVD and non-synovitis AEI tended to be lower in the second period (1.53 [0.3-2.78] vs. 0.69 [0.06-1.28 mg/dl], p=0.059). Two patients using [[tocilizumab]] developed iCVD despite persistently low CRP levels.

With progress in treatment, RA-related inflammation was better suppressed and CRP decreased, but the prevalence of RA among acute iCVD patients was unchanged. Strategies for tighter control of inflammation are needed, and a new [[biomarker]] may be required in patients using [[tocilizumab]]
((Hashimoto H, Kawamura M, Yukami T, Ishihara M, Bamba Y, Kaneshiro S, Tsuboi H,
Yamamoto K. Etiology of acute ischemic cerebrovascular disease associated with
rheumatoid arthritis: Changes with progression of anti-inflammatory therapy. Eur 
J Neurol. 2018 Jul 11. doi: 10.1111/ene.13751. [Epub ahead of print] PubMed PMID:
29995999.
)).