Anti-CD-20 Therapy in Refractory Adult Still’s Disease英文文献资料.docVIP

Open Journal of Rheumatology and Autoimmune Diseases, 2012, 2, 3-5 3 /10.4236/ojra.2012.22002 Published Online May 2012 (http://www.SciRP.org/journal/ojra) Anti-CD-20 Therapy in Refractory Adult Still’s Disease Reem Hamdy A. Mohammed Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University Hospitals, Taif, KSA. Email: rmhamdy@ Received October 27 , 2011; revised November 22 , 2011; accepted December 2 , 2011 th nd nd ABSTRACT Adult Still’s disease is a relatively rare form of rheumatoid arthritis with systemic inflammatory features. The preva- lence is around 1.5 cases per 100,000 - 1000,000. In the current case we display a 30-year-old male patient with refrac- tory adult still’s disease who suffered recurrent attacks of fever 39.5?C, arthritis in proximal interphalangeal joints (PIPs), wrists, tempromandibular joints (TMJs), knees and ankles, stitching chest pain, dyspnea, erythematous rash over the trunk, sore throat, weight loss (15 Kilograms in 4 months). The patients’ disease remained uncontrolled despite of synthetic disease modifying anti-rheumatic drugs and repeated intramuscular corticosteroid injections. Laboratory workup revealed erythrocyte sedimentation rate (ESR) of 95, C-reactive protein (CRP) of 100 mg/L, hemoglobin 10.5 gm%, leukocytosis 12,000/microlitre, mild elevation of liver function tests and dyslipidemia. Serology revealed nega- tive rheumatoid factor, anti-nuclear antibody titre of 1:80, elevated serum ferritin 4000 micrograms/litre. The patient was started on rituximab (375 mg/m 2 ), prednisolone 20 mg/day and selective Cox-2 inhibitor. Follow up for over three months following the completion of his pulse therapy, revealed no relapse of fever or fatigue, with morning stiffness of 5 - 10 minutes, VAS of 3, DAS28 of 3.8, H