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Tocilizumab Complications — SCE Rheumatology MCQ

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HardRheumatology PharmacologyTocilizumab ComplicationsSCE Rheumatology

A patient taking tocilizumab develops abdominal pain and CT confirms diverticular perforation, although fever and CRP elevation were modest. Why can the presentation be deceptively mild?

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Correct answer: B — IL-6 blockade suppresses CRP and attenuates inflammatory signs

The best answer is “IL-6 blockade suppresses CRP and attenuates inflammatory signs”. Tocilizumab directly suppresses hepatic acute-phase signaling, so serious infection or gastrointestinal perforation may occur with a low CRP and less prominent fever. It does not anesthetize the abdomen or simply raise luminal pressure, and the blunted presentation is clinically related to its mechanism.

Reference: BSR biologic DMARD safety guideline: https://academic.oup.com/rheumatology/article/58/2/e3/5076446