Single Patient Use of Tocilizumab in Systemic Onset Juvenile Idiopathic Arthritis

Inclusion Criteria: * Systemic Juvenile Idiopathic Arthritis according to ILAR criteria (2001) * Duration of disease ≥ 6 months since onset * Presence of active disease as determined by the presence of at least 5 active joints, OR at least 2 active joints if receiving prednisone at a dose \> 0.2 mg/kg/day or \> 10 mg/day (whichever is less) * Incomplete prior response to methotrexate treatment for at least 3 months at a minimum dose of 15 mg/M2/week, or intolerance to methotrexate * Discontinued treatment with other biologics prior to first tocilizumab infusion, for approximately two pharmacokinetic half-lives as per specific biologic (e.g. 48 hours for anakinra, 7 days for etanercept) * Not receiving corticosteroids, OR taking oral corticosteroids and the dose has remained stable for 1 week prior to the first tocilizumab infusion at ≤ 2 mg/kg/day prednisone or prednisolone and no more than 80 mg/day Exclusion Criteria: * Concomitant administration of biologic therapies * Serum creatinine \>1.5 ULN (upper limits normal) * AST or ALT \> 1.5 ULN * Total bilirubin \> 1.3 mg/dL * Platelet count \< LLN (lower limits normal) * Hemoglobin \< 6.0 g/dL * WBC count \< 5,000/mm3 * Neutrophil count \< 2,000/ mm3 * Fibrinogen \< LLN