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EXPERIENCE OF TREATMENT WITH RITUXIMAB IN PATIENT WITH JUVENILE POLYARTERITIS

Abstract

The article presents a case report of severe course of nodular polyarteritis. The disease was highly active, aggressive, and refractory to treatment with corticosteroids and cyclophosphamide combined with plasmapheresis and drugs for microcirculation improvement. The treatment with chimerical anti-CD20 monoclonal antibodies — rituximab — was successful. Symptoms of intoxication and tromboangiatic syndrome decreased in 4 weeks. Disease was stopped up to 16th week. The case report demonstrates high efficacy of rituximab: patient with severe nodular polyarteritis remains clinical and laboratory remission during 52 weeks.
Key words: children, nodular polyarteritis, rituximab.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (2): 193–200)

About the Authors

E.I. Alexeeva
Scientific Center of Children’s Health, Russian Academy of Medical Sciences, Moscow I.M. Sechenov First Moscow State Medical University
Russian Federation


T.V. Sleptsova
Scientific Center of Children’s Health, Russian Academy of Medical Sciences, Moscow
Russian Federation


S.I. Valieva
Scientific Center of Children’s Health, Russian Academy of Medical Sciences, Moscow
Russian Federation


T.M. Bzarova
Scientific Center of Children’s Health, Russian Academy of Medical Sciences, Moscow
Russian Federation


K.B. Isaeva
Scientific Center of Children’s Health, Russian Academy of Medical Sciences, Moscow
Russian Federation


R.V. Denisova
Scientific Center of Children’s Health, Russian Academy of Medical Sciences, Moscow
Russian Federation


E.V. Mitenko
Scientific Center of Children’s Health, Russian Academy of Medical Sciences, Moscow
Russian Federation


References

1. Лыскина Г.А. Узелковый полиартериит. Детская ревматология. Под общей ред. А.А. Баранова, Л.К. Баженовой. М.: Медицина. 2002. С. 228–243.

2. Лыскина Г.А. Узелковый полиартериит. Кардиология и ревматология детского возраста. Под общей ред. Г.А. Самсыгиной, М.Ю. Щербаковой. М. 2004. С. 228–243.

3. Исаева Л.А., Лыскина Г.А. Узелковый полиартериит у детей. М.: Медицина. 1984. С. 5–11, 48–165.

4. Dillon M.J. Vasculitis treatment — new therapeutic approaches. Eur. J. Pediatr. 2006; 165: 351–357.

5. Langford C.A. Small vessel vasculitis: therapeutic management. Curr. Rheumatol. Rep. 2007; 9: 328–335.

6. Wright E., Dillon M.J., Tullus K. Childhood vasculitis and plasma exchange. Eur. J. Pediatr. 2007; 166: 145–151.

7. Brogan P.A., Dillon M.J. The use of immunosuppressive and cytotoxic drugs in non-malignant disease. Arch. Dis. Child. 2000; 83: 259–264.

8. Jayne D. How to induce remission in primary systemic vasculitis. Best Pract. Res. Clin. Rheumatol. 2005; 19: 293–305.

9. Noorchashm H., Noorchashm N., Kern J. et al. B-cells are required for the initiation of insulitis and sialitis in nonobese diabetic mice. Diabetes. 1997; 46: 941–946.

10. Chan O.T., Hannum L.G., Haberman A.M. et al. A novel mouse with B cells but lacking serum antibody reveals an antibodyindependent role for B cells in murine lupus. J. Exp. Med. 1999; 189: 1639–1648.

11. Takemura S., Braun A., Crowson C. et al. Lymphoid neogenesis in rheumatoid synovitis. J. Immunol. 2001; 167: 1072–1080.

12. O’Neill S.K., Shlomchik M.J., Glant T.T. et al. Antigenspecific B cells are required as APCs and autoantibody-producing cells for induction of severe autoimmune arthritis. J. Immunol. 2005; 174: 3781–3788.

13. Balint G., Gergely P. Clinical immunotoxicity of antirheumatic drugs. Inflamm. Res. 1996; 45: 91–95.

14. Flato B., Vinje O., Forre O. Toxicity of antirheumatic and anti-inflammatory drugs in children. Clin. Rheumatol. 1998; 17: 505–510.

15. Anolik J.H., Barnard J., Cappione A. et al. Rituximab improves peripheral B cell abnormalities in human systemic lupus erythematosus. Arthritis Rheum. 2004; 50: 3580–3590.

16. Eriksson P. Nine patients with anti-neutrophil cytoplasmic antibody-positive vasculitis successfully treated with rituximab. J. Intern. Med. 2005; 257: 540–548.

17. Aries P.M., Hellmich B., Voswinkel J. et al. Lack of efficacy of rituximab in Wegener’s granulomatosis with refractory granulomatous manifestations. Ann. Rheum. Dis. 2006; 6: 853–858.

18. Smith K.G., Jones R.B., Burns S.M. et al. Long-term comparison of rituximab treatment for refractory systemic lupus erythematosus and vasculitis: remission, relapse, and retreatment. Arthritis Rheum. 2006; 54: 2970–2982.

19. Stasi R., Stipa E., Del P.G. et al. Long-term observation of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis treated with rituximab. Rheumatology (Oxford). 2006; 45: 1432–1436.

20. Keogh K.A., Ytterberg S.R., Fervenza F.C. et al. Rituximab for refractory Wegener’s granulomatosis: report of a prospective, open label pilot trial. Am. J. Respir. Crit. Care Med. 2006; 173: 180–187.

21. Keogh K.A., Wylam M.E., Stone J.H. et al. Induction of remission by B lymphocyte depletion in eleven patients with refractory anti–neutrophil cytoplasmic аnti–body associated vasculitis. Arthritis Rheum. 2005; 52: 262–268.

22. Omdal R., Wildhagen K., Hansen T. et al. Anti–CD20 therapy of treatment-resistant Wegener’s granulomatosis: favourable but temporary response. Scand. J. Rheumatol. 2005; 34: 229–232.

23. Jansson A.F., Sengler C., Kummerle–Deschner J. B–cell depletion for autoinflammatory diseases in pediatric patients a retrospective study. Ann. Rheum. Dis. 2009; 68 (3): 300.

24. El–hallak M., Binstadt B.A., Leichtner A.M. et al. Clinical effects and safety of rituximab for treatment of refractory pediatric autoimmune diseases. J. Pediatr. 2007; 150 (4): 376–382.

25. Binstadt B., Caldas A., Stuart E. Rituximab therapy for multisystem autoimmune diseases in pediatric patients. J. Pediatr. 2003; 143: 598–604.

26. Polido–Pereira J., Ferreira D., Rodrigues A. et al. Rituximab use in pediatric autoimmune diseases: four case reports. Ann. NY. Acad. Sci. 2009; 1173: 712–720.

27. Eriksson P. Nine patients with anti–neutrophil cytoplasmic antibody positive vasculitis successfully treated with rituximab. J. Intern. Med. 2005; 257: 540–548.


Review

For citations:


Alexeeva E., Sleptsova T., Valieva S., Bzarova T., Isaeva K., Denisova R., Mitenko E. EXPERIENCE OF TREATMENT WITH RITUXIMAB IN PATIENT WITH JUVENILE POLYARTERITIS. Current Pediatrics. 2011;10(2):193-200.

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