A prospective observational study on efficacy of modified rheumatoid arthritis protocol of rituximab (2000 mg) on patients of pemphigus

Background: Rituximab (RTX), an anticluster of differentiation 20 antibody, targets B lymphocytes, has been shown in open series studies to be effective in treating pemphigus. The objective was to evaluate whether a modified rheumatoid arthritis protocol, in which the patient received four doses of 500 mg of rituximab at an interval of two weeks was safe and effective in pemphigus management.Methods: It was a prospective observational study in which 46 pemphigus patients included and four doses of 500 mg of RTX at an interval of two weeks given and number of doses required for complete remission (CR), proportion of patient respond partially or doesn’t respond or relapsed after CR.Results: We enrolled 46 patients in the study, 8 with pemphigus foliaceus (PF) and 38 with pemphigus vulgaris (PV). 20 were male and 26 were female followed up for 15±4.24 months (12-18). All patient responded to therapy. CR of 23 patient after 2 dose OF 500 mg RTX ,of 18 patient after 3 dose, 5 patient partial remission (PR) after 4 doses. All patient were on 100 mg OD azathioprine. PR, all have oral lesions got CR after 3 weeks of 4th dose. 3 patients relapsed MD 11±2.8 months (9-13 months) and given additional dose of 500 mg RTX and got resolved in 3 weeks.Conclusions: We found modified rheumatic arthritis protocol for RTX was shown to be effective in treatment of pemphigus patient and relapse cases with additional dose. Immunological assay were not performed to limit the study.

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POS0441 DEVELOPMENT OF RHEUMATOID ARTHRITIS AMONG ANTI-CITRULLINATED PROTEIN ANTIBODIES POSITIVE ASYMPTOMATIC INDIVIDUALS: A PROSPECTIVE OBSERVATIONAL STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.344 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 449.1-449

Author(s):

S. Mizuki ◽

K. Horie ◽

K. Imabayashi ◽

K. Mishima ◽

K. Oryoji

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Observational Study ◽

Rheumatoid Factor ◽

Prospective Observational Study ◽

Enzyme Linked Immunosorbent Assay ◽

P Value ◽

Healthy Population ◽

Asymptomatic Individuals ◽

Citrullinated Protein

Background:In the idividuals with genetic and enviromental risk factors, immune events at mucosal surfaces occur and may precede systemic autoimmunity. Anti-citrullinated protein antibodies (ACPA) are present in the serum for an average of 3-5 years prior to the onset of rheumatoid arthritis (RA) during an asymptomatic period. In ACPA-positivite individuals, the additional presence of RA-related risk factors appears to add significant power for the development of RA. To date, there have been few reports in which clinical courses of ACPA-positive asymptomatic individuals were investigated prospectively.Objectives:To observe the clinical time course of ACPA-positive healthy population for the development of RA.Methods:Healthy volunteers without joint pain or stiffness, who attended the comprehensive health screening of our hospital, were enrolled in this prospective observational study. The serum ACPA levels were quantified by Ig-G anti-cyclic citrullinated peptide enzyme-linked immunosorbent assay with levels > 4.4 U/mL considered positive. ACPA-positive subjects were followed by rheumatologists of our department clinically or a questionnaire sent by mail for screening to detect arthritis.Results:5,971 healthy individuals without joint symptons were included. Ninty-two (1.5%) were positive for ACPA. Of these, 19 (20.7%) developed RA and two were suspected as RA by mail questionnaire. Their average age were 58-years, and women were 68%. The average duration between the date of serum sampling and diagnosis was 10.7 months. ACPA-positive individuals who developed to RA had higher serum ACPA and Ig-M rheumatoid factor levels than ACPA-positive individuals who did not (P value by Mann-Whitney U test: 0.002, 0.005, respectively).Conclusion:Among ACPA-positive asymptomatic individuals, 20% developed RA. The higher titer of ACPA and Ig-M rheumatoid factor levels are risk factors for devoloping RA.Disclosure of Interests:None declared

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