TY - JOUR T1 - Immunologic Reconstitution After Rituximab in Systemic Lupus Erythematosus: Why Should We Care? JF - The Journal of Rheumatology JO - J Rheumatol SP - 587 LP - 589 DO - 10.3899/jrheum.101350 VL - 38 IS - 4 AU - JENNIFER ANOLIK Y1 - 2011/04/01 UR - http://www.jrheum.org/content/38/4/587.abstract N2 - There is great interest in the role of B cells in autoimmune inflammatory diseases, running the spectrum from traditionally viewed B cell-centric diseases such as systemic lupus erythematosus (SLE) to rheumatoid arthritis (RA) to conventionally viewed T cell-mediated conditions such as multiple sclerosis. Although there is controversy regarding the place of B cell depletion in the SLE treatment armamentarium given the failure of 2 recent placebo-controlled trials (EXPLORER and LUNAR)1, this therapy is still used in the rheumatology community, particularly for refractory disease. Given the variability in response, I would argue that it is even more critical to understand how B cell depletion is efficacious and whether there are subsets of patients who will respond particularly well to B cell approaches as opposed to other treatment modalities.The article by Iwata and colleagues2 in this issue of The Journal examines changes in peripheral blood B and T cells longitudinally in 10 patients with active SLE treated with rituximab and attempts to correlate these changes with clinical response and relapse. A central finding is that prolonged remissions (in 8/10 patients) are associated with prolonged reductions in the fractions of both memory B and T cells, as well as downregulation of activation markers, including CD80 on B cells and CD40L, CD69, and inducible costimulator (ICOS) on T cells. An unfortunate omission is the absence of flow cytometry analysis in the 2 nonresponders. Other limitations of their study include the small numbers of patients studied, the limited T cell analyses (no T regulatory or T helper cell data), and incomplete definition of B cell subsets, with a notable lack of … Address correspondence to Dr. Anolik. E-mail: jennifer_anolik{at}urmc.rochester.edu ER -