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Rituximab-induced regression of CREST-related calcinosis

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Abstract

About a quarter of sclerodermic patients present calcinosis. However, patients with limited form of the disease are more likely to have calcinosis than patients with diffuse form. We report a case of a 54-year-old female patient with limited cutaneous scleroderma using rituximab (RTX) to treat lung fibrosis and arthritis. Into RTX treatment, she also had a complete resolution of calcinosis in her hands. The patient reported improvement in dyspnea and synovitis after two courses of RTX (four weekly infusions 375 mg/m2 each). After 7 months of the first infusion, the calcinosis in her fingers had a complete remission, especially the right thumb. Based on current evidences, we discuss the use of rituximab as a promising therapy to treat not only lung disease but also calcinosis in patients with scleroderma.

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References

  1. Robertson LP, Marshall RW, Hickling P (2003) Treatment of cutaneous calcinosis in limited systemic sclerosis with minocycline. Ann Rheum Dis 62(3):267–269

    Article  PubMed  CAS  Google Scholar 

  2. Boulman N, Slobodin G, Rozenbaum M, Rosner I (2005) Calcinosis in rheumatic diseases. Semin Arthritis Rheum 34(6):805–812

    Article  PubMed  Google Scholar 

  3. Reiter N, El-Shabrawi L, Leinweber B, Berghold A, Aberer E (2011) Calcinosis cutis: part II. Treatment options. J Am Acad Dermatol 65(1):15–22, quiz 23–4

    Article  PubMed  Google Scholar 

  4. Slimani S, Abdessemed A, Haddouche A, Ladjouze-Rezig A (2010) Complete resolution of universal calcinosis in a patient with juvenile dermatomyositis using pamidronate. Joint Bone Spine 77(1):70–72

    Article  PubMed  Google Scholar 

  5. Daoussis D, Antonopoulos I, Liossis SN, Yiannopoulos G, Andonopoulos AP (2012) Treatment of systemic sclerosis-associated calcinosis: a case report of rituximab-induced regression of CREST-related calcinosis and review of the literature. Semin Arthritis Rheum 41(6):822–829

    Article  PubMed  Google Scholar 

  6. Haroon M, McLaughlin P, Henry M, Harney S (2011) Cyclophosphamide-refractory scleroderma-associated interstitial lung disease: remarkable clinical and radiological response to a single course of rituximab combined with high-dose corticosteroids. Ther Adv Respir Dis 5(5):299–304

    Article  PubMed  CAS  Google Scholar 

  7. Daoussis D, Liossis SN, Tsamandas AC, Kalogeropoulou C, Kazantzi A, Sirinian C, Karampetsou M, Yiannopoulos G, Andonopoulos AP (2010) Experience with rituximab in scleroderma: results from a 1-year, proof-of-principle study. Rheumatology (Oxford) 49(2):271–280

    Article  CAS  Google Scholar 

  8. McGonagle D, Tan AL, Madden J, Rawstron AC, Rehman A, Emery P, Thomas S (2008) Successful treatment of resistant scleroderma-associated interstitial lung disease with rituximab. Rheumatology (Oxford) 47(4):552–553

    Article  CAS  Google Scholar 

  9. Tashkin DP, Scleroderma Lung Study Research Group et al (2006) Cyclophosphamide versus placebo in scleroderma lung disease. N Engl J Med 354(25):2655–2666

    Article  PubMed  CAS  Google Scholar 

  10. Daoussis D, Liossis SN, Yiannopoulos G, Andonopoulos AP (2011) B-cell depletion therapy in systemic sclerosis: experimental rationale and update on clinical evidence. Int J Rheumatol 2011(214013):7

    Google Scholar 

  11. Lafyatis R, Kissin E, York M, Farina G, Viger K, Fritzler MJ, Merkel PA, Simms RW (2009) B cell depletion with rituximab in patients with diffuse cutaneous systemic sclerosis. Arthritis Rheum 60(2):578–583

    Article  PubMed  Google Scholar 

  12. Chiu YE, Co DO (2011) Juvenile dermatomyositis: immunopathogenesis, role of myositis-specific autoantibodies, and review of rituximab use. Pediatr Dermatol 28(4):357–367

    Article  PubMed  Google Scholar 

  13. Edouard S, Sailler L, Sagot C, Munsch C, Astudillo L, Arlet P (2010) Un pouce douloureux (A painful thumb). La Revue de Médecine Interne 31:712–713

    Article  PubMed  CAS  Google Scholar 

  14. Bader-Meunier B, Decaluwe H, Barnerias C, Gherardi R, Quartier P, Faye A, Guigonis V, Pagnier A, Brochard K, Sibilia J, Gottenberg JE, Bodemer C (2011) Safety and efficacy of rituximab in severe juvenile dermatomyositis: results from 9 patients from the French Autoimmunity and Rituximab registry. J Rheumatol 38(7):1436–1440

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Faculty of Medicine, Federal University of Paraná, Curitiba, Brazil

    Dayane Raquel de Paula, Fabiane Barbero Klem & Pedro Gabriel Lorencetti

  2. Scleroderma Outpatient Clinic, Hospital de Clinicas, Federal University of Paraná, Curitiba, Brazil

    Carolina Muller

  3. Hospital de Clinicas, Federal University of Paraná, Rua Lamenha Lins 1110- ap11a Rebouças, Curitiba, Paraná, Brazil, 80250-020

    Valderilio Feijó Azevedo

  4. Edumed-Health Research and Education, Rua Lamenha Lins 1110- ap11a Rebouças, Curitiba, Paraná, Brazil, 80250-020

    Valderilio Feijó Azevedo

Authors
  1. Dayane Raquel de Paula
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  2. Fabiane Barbero Klem
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  3. Pedro Gabriel Lorencetti
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  4. Carolina Muller
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  5. Valderilio Feijó Azevedo
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Correspondence to Valderilio Feijó Azevedo.

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de Paula, D.R., Klem, F.B., Lorencetti, P.G. et al. Rituximab-induced regression of CREST-related calcinosis. Clin Rheumatol 32, 281–283 (2013). https://doi.org/10.1007/s10067-012-2124-z

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  • DOI: https://doi.org/10.1007/s10067-012-2124-z

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