Centre for Arthritis & Rheumatism Excellence (CARE), Cochin, India.
Clin Rheumatol. 2019 Sep;38(9):2399-2402. doi: 10.1007/s10067-019-04578-2. Epub 2019 May 10.
Rituximab (RTX) provides significant clinical benefits in active rheumatoid arthritis (RA) patients with inadequate response to DMARDs and anti-TNF. There is no data regarding efficacy of RTX in seropositive Palindromic Rheumatism (PR), a forerunner of RA.
To determine the efficacy and safety of RTX treatment in active PR patients exhibiting inadequate response to conventional synthetic DMARDs (csDMARDs).
The retrospective study, over a period of 3 years, included seropositive (RF ± antiCCP) PR patients with inadequate control of PR (> 4 attacks per months) despite combination csDMARDs and were treated with RTX. All the patients were treated with an initial dose of 500 mg RTX and later with a second infusion after 2 weeks' period in those who did not achieve adequate/ complete disease control. Patients were continued on csDMARDS and retreated with RTX on relapse of symptoms.
Thirty-three seropositive PR patients with a mean age of 48.15 ± 14.2 years, mean disease duration of 68.4 ± 68.2 months, mean follow up period of 24.3 ± 10.8 months, were treated with RTX. 88% patients were on combination DMARDS and 79% patients were females. All patient achieved rapid and complete control of palindromic attacks with RTX. Fifteen patients had a relapse after a mean duration of 10.4 ± 5.5 months and needed repeat RTX infusions following which remission was achieved. None of the patients progressed to RA till the end of the follow-up. No serious adverse effects were recorded.
RTX treatment could be effective in achieving disease control in active palindromic rheumatism not responding to csDMARDs.
• PR is thought to be a forerunner of RA and rituximab (RTX) has been found to be effective in RA. • Our study supports the hypothesis that B cells play an important role in the pathophysiology of PR and that the combination (RTX+ conventional drugs) can prevent the disease evolution into RA. • This 3-year retrospective study showed that rituximab was found to be effective in those who responded poorly to conventional drugs and remission was achieved in all patients. • Although it is a rare disease, we see palindromic rheumatism patients in India more often. As the symptoms are very debilitating in these patients, in those patients, not controlled on conventional drugs, rituximab offers newer promise in controlling the attacks and prevents further progression to RA.
利妥昔单抗（RTX）在对 DMARDs 和抗 TNF 反应不足的活动性类风湿关节炎（RA）患者中提供了显著的临床益处。对于 RA 的前驱物——血清阳性的回旋性风湿症（PR）患者，尚无关于 RTX 疗效的数据。
确定 RTX 治疗对常规合成 DMARDs（csDMARDs）反应不足的活动性 PR 患者的疗效和安全性。
这项回顾性研究在 3 年期间纳入了血清阳性（RF ±抗 CCP）PR 患者，这些患者尽管联合使用 csDMARDs，但 PR 仍控制不佳（每月>4 次发作），并接受 RTX 治疗。所有患者均接受初始剂量 500mg RTX 治疗，对于未达到充分/完全疾病控制的患者，在 2 周后给予第二次输注。患者继续接受 csDMARDs 治疗，并在症状复发时再次接受 RTX 治疗。
33 例血清阳性 PR 患者，平均年龄 48.15±14.2 岁，平均病程 68.4±68.2 个月，平均随访时间 24.3±10.8 个月，接受 RTX 治疗。88%的患者联合使用 DMARDs，79%的患者为女性。所有患者均迅速且完全控制了 PR 的发作。15 例患者在平均 10.4±5.5 个月后复发，需要重复 RTX 输注，随后达到缓解。在随访结束时，没有患者进展为 RA。未记录到严重的不良反应。
RTX 治疗可有效控制对 csDMARDs 反应不佳的活动性回旋性风湿症。
PR 被认为是 RA 的前驱物，利妥昔单抗（RTX）已被证明对 RA 有效。
我们的研究支持这样的假设，即 B 细胞在 PR 的病理生理学中起重要作用，并且联合治疗（RTX+常规药物）可以防止疾病向 RA 进展。
这项为期 3 年的回顾性研究表明，RTX 对常规药物反应不佳的患者有效，所有患者均达到缓解。
虽然这是一种罕见疾病，但我们在印度更经常看到回旋性风湿症患者。由于这些患者的症状非常虚弱，对于那些未通过常规药物控制的患者，利妥昔单抗在控制发作方面提供了新的希望，并防止进一步进展为 RA。
