Rituximab for prevention of strokes in cerebral rheumatoid vasculitis

Rheumatoid arthritis (RA) is an autoimmune disorder which manifests as inflammation of the synovial joints alongside extra-articular involvement. Uncommonly, patients may develop vasculitis of small and medium-sized blood vessels, formally diagnosed as systemic rheumatoid vasculitis (SRV). In partic...

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Bibliographic Details
Published in:Clinical neurology and neurosurgery 2022-04, Vol.215, p.107199-107199, Article 107199
Main Authors: Fana, Michael, Chao, Shing, Katramados, Angelos M.
Format: Article
Language:English
Subjects:
Arthritis, Rheumatoid - complications
Arthritis, Rheumatoid - diagnosis
Arthritis, Rheumatoid - drug therapy
Biopsy
Blood vessels
Cerebral rheumatoid vasculitis
Humans
Immunologic Factors
Immunomodulation
Immunotherapy
Joint diseases
Laboratories
Monoclonal antibodies
Mortality
Patients
Prevention
Remission
Rheumatoid arthritis
Rheumatoid Vasculitis - diagnosis
Rituximab
Rituximab - therapeutic use
Steroid hormones
Steroids
Stroke
Stroke - drug therapy
Stroke - etiology
Stroke - prevention & control
Systemic rheumatoid vasculitis
Vasculitis
Vasculitis, Central Nervous System - complications
Vasculitis, Central Nervous System - drug therapy
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Summary:Rheumatoid arthritis (RA) is an autoimmune disorder which manifests as inflammation of the synovial joints alongside extra-articular involvement. Uncommonly, patients may develop vasculitis of small and medium-sized blood vessels, formally diagnosed as systemic rheumatoid vasculitis (SRV). In particularly rare cases, patients may develop a subtype of SRV known as cerebral rheumatoid vasculitis (CRV) which manifests in patients as stroke. To date, no formal recommendations or guidelines have been established for treatment and prevention of CRV-induced stroke besides experiential therapy with various immunomodulators. Here, we describe the utility of Rituximab in addition to steroids for prevention of stroke in our patient with evidence of multiple CRV-induced strokes with excellent recovery of post-stroke symptoms and remission of new onset cerebral vasculitis processes. •Cerebral rheumatoid vasculitis is a rare complication of rheumatoid arthritis.•No current treatment guidelines exist for prevention of strokes in CRV.•Rituximab is an efficacious treatment option for prevention of CRV-induced strokes.
ISSN:0303-8467
1872-6968
DOI:10.1016/j.clineuro.2022.107199