Suzuki Koji, Akiyama Mitsuhiro, Takei Hiroshi, Kaneko Yuko
Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Rheumatol Int. 2024 Dec 18;45(1):2. doi: 10.1007/s00296-024-05759-2.
Cold agglutinin disease, a subtype of cold-type autoimmune hemolytic anemia, is referred to as cold agglutinin syndrome (CAS) when it develops secondary to other conditions. Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by the peripheral destruction of platelets. While both CAS and ITP can occur in patients with rheumatoid arthritis (RA), their concurrent manifestation in a single patient has not been reported, leaving the optimal treatment strategy for such a complex case unclear. Given that rituximab has been reported to be effective in treating RA, CAS, and ITP, it may be a promising treatment option for cases where these three conditions co-occur. We present the first case of RA complicated by both CAS and ITP, where the patient achieved complete remission with rituximab therapy. Furthermore, our review of the literature identified three cases of CAS and three cases of ITP in RA patients, all successfully treated with rituximab. These findings highlight the potential efficacy of rituximab in managing this challenging and potentially life-threatening combination of autoimmune diseases.
冷凝集素病是冷型自身免疫性溶血性贫血的一种亚型，继发于其他疾病时被称为冷凝集素综合征（CAS）。免疫性血小板减少症（ITP）是一种自身免疫性疾病，其特征是血小板在周围被破坏。虽然CAS和ITP都可发生于类风湿关节炎（RA）患者，但尚未有二者在同一患者中同时出现的报道，因此对于这种复杂病例的最佳治疗策略尚不清楚。鉴于有报道称利妥昔单抗在治疗RA、CAS和ITP方面有效，对于这三种情况同时出现的病例，它可能是一种有前景的治疗选择。我们报告了首例并发CAS和ITP的RA病例，该患者接受利妥昔单抗治疗后完全缓解。此外，我们对文献的回顾发现了3例RA患者合并CAS以及3例RA患者合并ITP的病例，所有这些病例均通过利妥昔单抗成功治疗。这些发现凸显了利妥昔单抗在治疗这种具有挑战性且可能危及生命的自身免疫性疾病组合方面的潜在疗效。
