Association of ANCA-associated vasculitis-rheumatoid arthritis overlap syndrome in four patients: rituximab may be the right choice?

Autor: Szilasi M; Department of Pulmonology, University of Debrecen Medical and Health Sciences Center, Debrecen, Hungary., Mátyus J, File I, Szücs G, Rákóczi E, Pfliegler G, Szabó Z, Végh E, Szekanecz Z
Jazyk: angličtina
Zdroj: Autoimmunity [Autoimmunity] 2012 Jun; Vol. 45 (4), pp. 304-9. Date of Electronic Publication: 2012 Apr 10.
DOI: 10.3109/08916934.2012.677078
Abstrakt: Objectives: There have been few reports on the association of rheumatoid arthritis (RA) with anti-neutrophil cytoplasmic antigen (ANCA)-associated systemic vasculitides.
Methods: Here we present four cases of RA overlapping with Wegener's granulomatosis (WG), microscopic polyangiitis (MPA) and Churg-Strauss syndrome (CSS). All these cases had both the diagnosis of RA and that of ANCA-associated vasculitis.
Results: After we tried corticosteroids, multiple immunosuppressive drugs, sometimes plasmapheresis, rituximab was introduced to 3 out of 4 cases. Rituximab therapy was found to be effective in these three overlap cases. In the fourth case, rituximab was and will be considered; however, the patient has not given consent.
Conclusion: To our knowledge, this is the first report on RA+CSS association. Common pathogenic background, such as genetic predisposition and ANCA may account for the development of RA+vasculitis overlaps. In DMARD-refractory cases, such as the ones presented here, biologics, especially rituximab may be highly effective.
Databáze: MEDLINE
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