J Rheum Dis.  2012 Apr;19(2):100-103. 10.4078/jrd.2012.19.2.100.

A Case of Rituximab Use in Rheumatoid Arthritis Following Anti-TNF-Associated Tuberculosis

• Kim KH
• Moon KW
• Heo JW
• Lee WH
• Lee SH
• Jeong CM
• Park HS

• KMID: 2223108
• DOI: http://doi.org/10.4078/jrd.2012.19.2.100

Abstract

Rituximab has been shown to be effective in rheumatoid arthritis (RA) and is recommended for patients exhibiting an inadequate response to tumor necrosis factor (TNF) inhibitors. To date, there have been no reports of tuberculosis in RA patients treated with rituximab. We report the use of rituximab in a TNF inhibitor-refractory RA patient who had developed tuberculosis. A 52-year-old man with RA had been treated with adalimumab for 3 months, but failed to respond well to the treatment. He reported fever, coughing, sputum, and weight loss. He was diagnosed with pulmonary tuberculosis and started anti-tuberculosis medication. His arthritis was not controlled for despite increasing the dose of prednisolone. He was treated with rituximab without serious adverse effects. Sixteen weeks later, he demonstrated improvement with both arthritis and tuberculosis.

Keyword

Rheumatoid arthritis; TNF inhibitor; Rituximab; Tuberculosis

MeSH Terms

Antibodies, Monoclonal, Humanized
Antibodies, Monoclonal, Murine-Derived
Arthritis
Arthritis, Rheumatoid
Cough
Fever
Humans
Middle Aged
Prednisolone
Sputum
Tuberculosis
Tuberculosis, Pulmonary
Tumor Necrosis Factor-alpha
Weight Loss
Adalimumab
Rituximab
Antibodies, Monoclonal, Humanized
Antibodies, Monoclonal, Murine-Derived
Prednisolone
Tumor Necrosis Factor-alpha

Figure

• 

  Figure 1 Simple chest radiograph showed nodules and linear opacities in the right upper lobe prior to 3 months regarding admission (A). Progression of nodular infiltrates in the right upper lobe suggests the progression of active tuberculosis at admission (B).

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  Figure 2 High resolution computed tomography scan of the chest indicated multiple centrilobular nodules and nodular consolidation in the right upper lobe.

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