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Reminder of important clinical lesson
CASE REPORT
Successful treatment using rituximab in a patient with refractory polymyositis complicated by scleroderma renal crisis
  1. Kyoko Innami,
  2. Tomoyuki Mukai,
  3. Shoko Kodama,
  4. Yoshitaka Morita
  1. Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan
  1. Correspondence to Dr Yoshitaka Morita, morita{at}med.kawasaki-m.ac.jp

Summary

Corticosteroids are the first-line treatment for patients with inflammatory myopathies. Myositis can be a clinical feature of scleroderma (polymyositis–scleroderma overlap syndrome), and treatment of this syndrome is a challenge for clinicians because moderate to high doses of corticosteroids are considered a risk factor for development of acute kidney injury in affected patients. We report here the case of a 56-year-old woman with scleroderma who developed polymyositis and was successfully treated with rituximab. Initial treatment of the polymyositis with prednisolone 40 mg/day was rapidly tapered to 2.5 mg/day due to development of scleroderma renal crisis, for which four weekly infusions of rituximab (500 mg; off-label) were given. She responded well to rituximab in addition to prednisolone 2.5 mg/day. Rituximab may improve inflammatory myopathies, even in cases where high-dose corticosteroids should be avoided due to complications. Rituximab should be considered as a treatment option in cases of refractory polymyositis.

  • biological agents
  • connective tissue disease

https://doi.org/10.1136/bcr-2017-221205

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    Footnotes

    • Contributors KI and YM: involved in conception or design of the work. KI and SK: responsible for acquisition of data. KI, TM and YM: drafted the manuscript or revised. All authors: are responsible for analysis and interpretation of data.

    • Competing interests KI received scholarship donations from AbbVie, Actelion, Astellas, Bristol-Myers, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Japan Blood Products Organization, Mitsubishi-Tanabe, Pfizer, Shionogi, Takeda, Teijin, and UCB. TM received scholarship donations from AbbVie, Actelion, Astellas, Bristol-Myers, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Japan Blood Products Organization, Mitsubishi-Tanabe, Pfizer, Shionogi, Takeda, Teijin, and UCB. SK received scholarship donations from AbbVie, Actelion, Astellas, Bristol-Myers, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Japan Blood Products Organization, Mitsubishi-Tanabe, Pfizer, Shionogi, Takeda, Teijin, and UCB. YM received scholarship donations from AbbVie, Actelion, Astellas, Bristol-Myers, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Japan Blood Products Organization, Mitsubishi-Tanabe, Pfizer, Shionogi, Takeda, Teijin, and UCB.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.