Rituximab and PMR

Question

I’ve been treated for pmr/connective tissue disease for 4 years. After being on low dose prednisone for three years, I’ve been off it for one year while taking 20 mg methotrexate/week and 400 mg of plaquinal daily. I tolerated the prednisone fine but my Dr. felt it was worth the effort to get off but I’m ready to start up again because the pain is too much. What about rituxin? If there was a good chance it would help, I’d find a way to pay out of my own pocket. My rheumy feels it might be a few years before data would warrant such a course. Prednisone or rituxin?

Answer

Rituxan works by eliminating autoimmune B cells. It has been useful in RA (FDA approved) but also in other autoimmune diseases such as lupus, immune mediated thrombocytopenia, Wegener’s vasculitis. On a theoretical and in real life, Rituxan works the best when there are autoantibodies. For instance, in RA, patients who are RF or anti-CCP positive seem to respond better. Since in PMR, most patients do not have measurable autoantibodies, it seems unlikely that Rituxan will have much benefit.

Alan Matsumoto, M.D.

About Alan Matsumoto, M.D.

Part-time Faculty, Division of Rheumatology
Johns Hopkins University