Rituximab in the treatment of rheumatic diseases

Rheumatoid arthritis and other systemic connective tissue diseases are characterized by immune system hyper-reactivity and production of autoantibodies. Rituximab is a monoclonal antibody against CD20 molecule, which is present on the surface of the large population of B cells. Administration of rituximab leads to B lymphocyte depletion from peripheral circulation. This is associated with treatment effects and significant suppression of inflammation. The most advanced is the use of rituximab in rheumatoid arthritis, which has become recently a routine indication for this type of treatment. Rituximab is indicated together with methotrexate in active patients with rheumatoid arthritis who did not have sufficient response to at least one TNF inhibitor. Even in these resistant patients, rituximab can have a major clinical effect and slow the radiographic progression of the disease. Rituximab is administered intravenously in two separate infusions of 1000 mg and the effect usually persists many months. This treatment can be repeated and further infusions are associated with similar or better effect. Anti-CD20 therapy is being explored in several other systemic inflammatory diseases with promising results.

Keywords: rituximab, anti-CD20, rheumatoid arthritis, connective tissue diseases