TY - JOUR T1 - Atypical Psoriasis Following Rituximab for Rheumatoid Arthritis JF - The Journal of Rheumatology JO - J Rheumatol SP - 1303 LP - 1304 DO - 10.3899/jrheum.111256 VL - 39 IS - 6 AU - SARAH A. HARDCASTLE AU - SAM GIBBS AU - LYN WILLIAMSON Y1 - 2012/06/01 UR - http://www.jrheum.org/content/39/6/1303.abstract N2 - To the Editor:Rituximab (RTX) is a chimeric B cell-depleting monoclonal antibody used in the treatment of non-Hodgkin’s lymphoma and rheumatoid arthritis (RA), and with an emerging role in connective tissue disease therapy. Its use has rarely been associated with skin reactions, in particular psoriasiform skin lesions. We report a case of atypical psoriasis reactivation in a patient with RA following RTX, and we review the literature.A 49-year-old woman presented in 1999 with a seronegative polyarthritis affecting the hands, elbows, feet, hips, and knees. At the time she gave no history of psoriasis. Over the next 10 years she received several disease-modifying antirheumatic drugs (DMARD) sequentially and in combination including sulfasalazine, hydroxychloroquine, methotrexate, azathioprine, gold, and leflunomide. Disease activity persisted, although radiographs remained nonerosive. Her 28-joint Disease Activity Score (DAS28) in September 2010 was 6.45 despite triple DMARD therapy, and she was assessed for a biologic. RTX was chosen in preference to anti-tumor necrosis factor (TNF) treatment because of recurrent shingles and a previous positive Heaf test (chest radiograph normal, quantiferon test negative).In November 2010 … Address correspondence to Dr. S.A. Hardcastle, Department of Rheumatology, Osprey Unit, The Great Western Hospital, Marlborough Road, Swindon SN3 6BB, UK. E-mail: Sarah.Hardcastle{at}bristol.ac.uk ER -