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Tocilizumab (TCZ) has been approved for giant cell arteritis (GCA). Interleukin-6 (IL-6) receptor blockade suppresses clinical disease and is steroid sparing.1 2 Since IL-6 induces the acute-phase response, the clinically used inflammation markers (C reactive protein (CRP), erythrocyte sedimentation rate (ESR)) are suppressed during TCZ treatment. Whether serum IL-6 is useful in monitoring disease activity and detecting infections in TCZ-treated GCA is unknown. We longitudinally measured IL-6 in 23 patients with intravenous TCZ–treated GCA, two patients with polymyalgia rheumatica and one patient with Takayasu arteritis of our GCA cohort (EKBB-239/09), and in 13/26 patients additionally before TCZ treatment. Patient characteristics are shown in table 1. At each visit, clinical and laboratory parameters (white blood cell (WBC), CRP, ESR) were assessed. Relapse was defined as the need for treatment intensification following new or increasing symptoms, or rising CRP/ESR not otherwise explained.2 View this table: Table 1 Patient characteristics of ‘relapser’ and ‘non-relapser’ During TCZ therapy, CRP, ESR and WBC rapidly declined and were sustainably suppressed. IL-6 levels rose and remained elevated throughout TCZ treatment (figure 1). Daily prednisone doses were successfully tapered after TCZ was initiated (figure 1C). During 23.8 patient-years of TCZ therapy, eight infections were documented with available IL-6 levels (online supplementary table S1). IL-6, but not CRP, ESR …

Peripheral nerve biopsy remains the gold standard for diagnosing vasculitic neuropathy (VN).1 This procedure is invasive, of limited sensitivity and not always feasible.2 A biomarker indicating acute axonal loss in patients with systemic vasculitis would allow rapid screening and adjustments of diagnostic or treatment strategies, potentially improving clinical outcome.3 Neurofilaments are structural proteins specific to neurons that are released into blood and cerebrospinal fluid following neuronal damage. They have been suggested as a biomarker in various neurological diseases, mainly affecting the central nervous system.4–6 In patients with multiple sclerosis, serum neurofilament light chain (sNfL) levels correlated with MRI and clinical disease activity/severity, were lower in patients under treatment and showed potential to predict future disease activity and disability.5 In this retrospective study we aimed to test whether sNfL could serve as a marker of vasculitic damage of peripheral nerves and/or disease activity in patients with VN. Patients were recruited from our prospective local ethical board-approved vasculitis …