Rituximab in patients with rheumatoid arthritis and vasculitis-associated cutaneous ulcers

To test the efficacy of treatment with rituximab in refractory rheumatoid vasculitis in patients with rheumatoid arthritis (RA).

Retrospective study of four female patients with histologically proven RA associated vasculitic cutaneous ulcers. All patients developed the lesions on long term treatment with methotrexate or leflunomide, and three of them with tumour necrosis factor alpha (TNF) blockers. All patients were refractory to prednisolone in the dosage between 0.5 and 1 mg/kg body weight for at least 4 weeks prior to rituximab. Rituximab were administered in two intravenous applications in the interval of 14 days accompanied by continued treatment with methotrexate or leflunomide and prednisolone.

Three out of four patients achieved a rapid clinical remission of the lesions within 4 to 6 weeks after rituximab therapy continuing at least for four months with a successful corticoid reduction till prednisolone 10 mg a day. One patient showed no remission of the skin lesions accompanied by increasing levels for ESR and CRP.

Rituximab treatment seems to be very effective in several cases of vasculitis-associated cutaneous ulcers in RA patients. However, the effectiveness of rituximab in cases with this indication remains to be shown in larger number of patients.