Subacute Development of Polymyalgia Rheumatica (PMR) In Diabetic Patient with Clinical Efficacy of Tocilizumab and Xultophy

The patient is 76-year-old men with previous history of type 2 diabetes mellitus (T2DM) in 2012, acute myocardial infarct (AMI) in 2015 and dyslipidemia in 2017. He had no health or medical problems of rheumatism and joints. As his social and sports history, he was an excellent long-distance runner with the similar level to Olympian Kenji Kimihara during 14-30 years old. He worked hard from 38 years as city assembly member. In 2019, he continued low carbohydrate diet (LCD) with decreased HbA1c from 9.0% to 6.3% for half year. In autumn 2021, he developed subacute generalized arthralgia and muscle weakness with elevated HbA1c 10.6%. He was diagnosed as polymyalgia rheumatica (PMR). For treatment, prednisolone was not effective, and then he was provided Tocilizumab (Actemra). It showed remarkable efficacy for symptom improvement and normalized C-reactive protein (CRP) 8.3 to <0.1 mg/dL, matrix metalloproteinase-3 (MMP-3) 610 to 79 ng/mL. For glucose control, he was initiated insulin human 4-4-4 to 14-14-14 units, followed by Xultophy 18 to 5 doses with satisfactory glucose variability. HbA1c was remarkably decreased from 10.6% to 6.4 % about 2 months. Various discussion perspective was described, and this article will be hopefully useful for future practice and research.