Date: Sunday, November 8, 2015
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Between 16 and 20% of patients with systemic sclerosis (SS) have arthritis, which is occasionally erosive. In addition, between 1 and 5% of patients show syndrome overlap with rheumatoid arthritis (RA).
The initial management of this complication is typically similar to RA, with the use of methotrexate as a first-choice DMARD. In refractory cases, anti-TNF therapies could be useful. However, many of these patients develop diffuse interstitial lung disease (DILD), which contraindicates the use of these drugs.
Our objective was to evaluate the efficacy and safety of rituximab (RTX) in the treatment of joint disease in patients with SS.
An ambispective study of 13 patients with SS (ACR/EULAR 2013 criteria) and severe polyarticular disease treated with RTX was performed. The primary efficacy outcome was an improvement of joint counts, as evaluated by DAS28-ESR at the end of the follow-up period
Of the 13 patients included (12 women), seven (54%) had diffuse SS and six had a limited form of the disease. The mean age (± SD) was 54 ± 11 years, and the time of evolution (median) was 7 ± 12 years. Two (15%) patients had positive ACPA and fulfilled the criteria for RA classification. The baseline DAS28-ESR score was 6.4 ± 1.8.
The main clinical characteristics and response to treatment are shown in the following table.
|Indication||DAS28 at the beginning||Time tracking (months)||Number of cycles||DAS28 at last visit||Previous treatments|
|Polyarthritis + DILD||6.55||12||2||2.21||MTX, LEF, Etanercept|
|Polyarthritis (overlap RA)||6.47||18||3||3.01||MTX, LEF, D-penicilamina|
|Polyarthritis||6.61||18||3||2.45||MTX, LEF, D-penicilamina|
|Polyarthritis + DILD||7.92||18||3||2.31||CFM, MMF|
|Polyarthritis||6.78||12||2||2.41||MTX, SZP, MMF|
|Polyarthritis||7.88||6||1||6.66||MTX, SZP, LEF, HCQ|
|Polyarthritis||7.05||18||3||3.43||MTX, CFM, SZP, MMF|
|Polyarthritis + DILD||4.47||27||4||3.06||MMF|
|Polyarthritis + DILD||4.38||16||2||1.89||MMF|
|Polyarthritis + DILD + calcinosis||3.39||16||2||2.52||MMF|
|Polyarthritis + DILD + severe skin disease||4.85||48||4||2.12||MMF, Imatinib|
|Polyarthritis + DILD + severe skin disease + calcinosis||4.36||24||4||3.20||CFM|
|Polyarthritis + DILD||3.49||30||3||1.19||CFM, MMF|
RTX treatment was only ineffective in one patient (8%) and was suspended at six months because of ineffectiveness. In the remaining 12 patients (92%), a good control of joint counts was achieved, and at the end of the follow-up period (median ± SD) of 18 ± 10 months (range, 12-48), the mean DAS28-ESR score decreased to 2.8 ± 1.3 (% improvement: mean -46.89%; range, -70.83% to -15.48%). In eight patients (61%), joint disease remission (DAS28 < 2.6) was achieved. Three patients (23%) had low activity (DAS28 ≤ 3.2), and one (8%) had moderate activity.
The frequency of adverse effects was low, occurring in only two (15%) patients: one patient had two episodes of transient neutropenia (one feverish, prompting hospitalization), and the other had several mild infections (gastroenteritis, a urinary tract infection, and a respiratory infection). In neither of the two cases was it necessary to discontinue RTX treatment. In the patients with concomitant DILD, no worsening was observed in lung function tests.
In our experience, RTX is a safe and effective drug for the treatment of joint disease in patients with SS
To cite this abstract in AMA style:Borrell Paños H, Narváez J, Alegre JJ, Castellvi I, Albert Espi G, Heredia S, Toniolo E, Nolla JM. The Efficacy of Rituximab in Systemic Sclerosis Joint Disease: A Pilot Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/the-efficacy-of-rituximab-in-systemic-sclerosis-joint-disease-a-pilot-study/. Accessed September 19, 2019.
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