A Case Report of Adjuvant Molecular Hydrogen Therapy in Refractory Rheumatoid Arthritis With Atlantoaxial Subluxation

Abstract

Background/Aim: Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting synovial joints, often causing to joint destruction and systemic comorbidities. Cervical spine involvement, especially atlantoaxial subluxation (AAS), can lead to spinal cord compression and neurological deficits. While disease-modifying antirheumatic drugs (DMARDs) are standard therapy, intolerance to agents like methotrexate (MTX) in elderly or comorbid patients limits options. Molecular hydrogen, with antioxidant and anti-inflammatory properties, has emerged as a potential adjuvant in autoimmune diseases. This case report describes an elderly woman with long-standing, treatment-refractory RA and severe cervical spine disease who received molecular hydrogen therapy, highlighting immunological changes, clinical outcomes, and challenges in managing RA with complex comorbidities. Case Report: An 85-year-old Taiwanese woman with long-standing rheumatoid arthritis (2010 American College of Rheumatology/European League Against Rheumatism criteria) and multiple comorbidities discontinued methotrexate in 2016 due to pancytopenia. Her RA was managed with oral steroids and hydroxychloroquine, but she had recurrent hospitalizations for flares with multiple joint pain. Molecular hydrogen therapy was initiated in June 2023 as an adjuvant treatment. Fatigue, assessed using the Taiwan Brief Fatigue Inventory (BFI-T), improved notably across multiple domains, accompanied by dynamic changes in immune cell populations suggesting immunomodulatory effects. During this admission, atlantoaxial subluxation was diagnosed, fulfilling surgical criteria; however, the patient and her family declined surgery due to risk and prognosis, opting for palliative care until her death. Conclusion: This case highlights the potential immunomodulatory benefits of molecular hydrogen as an adjuvant therapy in rheumatoid arthritis. Although clinical and immunological improvements were observed, larger studies with longer follow-up are needed. It also illustrates severe cervical spine involvement, atlantoaxial subluxation, underscoring the complexity and neurological risks of advanced RA.