Case 2 is a 46-year-old male with a 11/2-year history of PsA and hypertension. He had a family history of psoriasis and rheumatoid arthritis. He failed adalimumab and certolizumab in the past, due to lack of efficacy.
He had psoriatic plaques over the waistline and gluteal fold, as well as tender proximal interphalangeal (PIP) joints. His RAPID-3 score was 7.5.
He was prescribed RCI 80 U BIW SC. After his third dose of RCI, he experienced remarkable improvement in joint pain and swelling. He stated that he was able to throw football with his son for the first time in 2 years. His skin disease "mostly cleared".
After approximately 12 weeks, his dose was lowered to RCI 40 U BIW SC, because he was responding well to 80 U BIW. His RAPID-3 score decreased slightly to 6.2. He believed the effect of RCI lasted for 48 hours after each dose, after which stiffness returned and his old skin lesions worsened. His dose was adjusted to RCI 20 U TIW SC. His dose was changed to help with the waning effect and because of weight gain (~4.5 kg) and worsening of existing, untreated hypertension.
While on RCI, he noted improvements in joint pain and skin lesions, and reported no joint swelling. However RCI was discontinued after 6 months, due to worsening existing hypertension and weight gain.