Rituxan (rituximab) may be effective in eliminating the symptoms of Raynaud’s disease, according to a case study reported by researchers in Saudi Arabia.
The study, “Severe Primary Raynaud’s Disease Treated with Rituximab,” published in the journal Case Reports in Rheumatology, describes the case of a 55-year-old woman who was diagnosed with severe primary Raynaud’s phenomenon, one of two types of the disease characterized by the narrowing of the blood vessels in the fingers and toes when exposed to cold or as a result of stress, temporarily limiting the blood supply.
The second type of the disease, called secondary Raynaud’s phenomenon, is less common but more severe. Unlike primary Raynaud’s disease, it is caused by an underlying medical condition, such as diseases of connective tissues and arteries.
It can also be caused by repetitive action, like typing or playing the piano, smoking, injury, or the use of certain medications, including drugs used to control high blood pressure, migraines, hyperactivity, and cancer.
The patient was initially treated with first-line agents, including calcium channel blockers; phosphodiesterase inhibitors; as well as aspirin, which is known to have blood-thinning properties. But this approach failed to control her symptoms, which worsened and led to ulcers and gangrene in her fingers.
Underlying conditions, such as autoimmune disease, cancer, or inflammation of the blood vessels, was not detected in the patient. Due to the fact that her condition led to critical restriction of blood supply to the fingers, she was given an injection of iloprost, a drug that dilates the blood vessels and that is often used for the treatment of pulmonary arterial hypertension (PAH).
She also received heparin infusion to thin her blood, followed by surgery to widen her blood vessels. This resulted in a partial improvement of her condition, but the symptoms persisted. She was then given two cycles of Rituxan treatment, which led to the complete elimination of her symptoms.
Rituxan is an antibody against a protein called CD20 that is found on the surface of certain types of immune system cells, called B-cells. The drug destroys B-cells, and is therefore used to treat conditions where B-cells are overactive, such as autoimmune diseases and certain types of cancers, including lymphoma and leukemia. It is also used in combination with methotrexate to treat symptoms of adult rheumatoid arthritis.
Although it is not clear whether autoantibodies produced by B-cells play a role in the development of Raynaud’s disease, previous research has shown that patients with the primary form of the condition have antibodies against type 4 collagen in their blood. This could explain the effective response to Rituxan therapy reported in this case.
However, the authors state in their report that additional studies are needed before making a definitive statement about the effectiveness of Rituxan in the treatment of Raynaud’s disease.
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