When should RTX be repeated? Can other immunosuppressive medications be used with it? Among RA patients, the response is variable. Patients who are seropositive (rheumatoid factor and/or anticyclic citrullinated peptide) and have hypergammaglobulinemia are more likely to respond. Most RA patients deplete their B cells after RTX. Those who deplete their plasmablasts (CD27 + CD38 + ) get the …
Biologic Agents 1. Biologic agents differ in their effectiveness for controlling specific rheumatic diseases depending on what immunologic process and/or cytokines are driving the patient’s inflammation. 2. Tumor necrosis factor (TNF) inhibitors are more effective when combined with methotrexate (MTX). 3. Interleukin-1 inhibitors are most effective for Still’s disease and the cryopyrinopathies. 4. Interleukin (IL) 6 receptor inhibitor is …
use of high dose immunoablative therapy with autologous hematopoietic stem cell transplantation for the treatment of severe autoimmune disease Autologous (using patient’s own stem cells) hematopoietic stem cell transplantation is a method of increasing the intensity of chemotherapy that can be given to a patient with a severe autoimmune disease who is failing standard therapy. …
In which rheumatic diseases is IVIG indicated? How might it work in these diseases? • Autoimmune thrombocytopenia: Fc portion of IVIG binds the Fc receptor on reticuloendothelial cells blocking the removal of antibody-coated cells. • Kawasaki disease: IVIG reduces expression of adhesion molecules on endothelial cells, binds cytokines that cause inflammation, reduces number of activated T cells, …
In which rheumatic diseases has PLEX been beneficial? • Thrombotic thrombocytopenia purpura (TTP) associated with rheumatic diseases. • Catastrophic antiphospholipid syndrome. • SLE: diffuse alveolar hemorrhage; neuropsychiatric lupus with coma; TTP. • Neuromyelitis optica spectrum disorder. • ANCA-associated vasculitis with diffuse alveolar hemorrhage and/or rapidly progressive crescentic glomerulonephritis (Cr >3.5; controversial). • Hepatitis B-associated polyarteritis nodosa (combined with antiviral agent). • Hepatitis …
In which rheumatic diseases has PLEX been beneficial Read More »
Why is plasma exchange used in the treatment of rheumatic diseases? Theoretically, PLEX should remove immune complexes and autoantibodies that contribute to the pathogenesis of some of the rheumatic diseases. It is most effective when used acutely to gain a rapid response in life-threatening situations. PLEX is usually used in combination with GCs and/or cytotoxic …
Why is plasma exchange used in the treatment of rheumatic diseases Read More »
How is IV gammaglobulin used as an immunomodulator in rheumatic diseases? • Available formulations: multiple suppliers; solution concentrations vary from 3% to 12% Ig; cost is $100 to $300/g. • Dosage: 1 to 2 g/kg administered over 1 to 5 days. • Side effects: headache (2%–20%), flushing, chest tightness, back pain/myalgias, fever, chills, nausea, diaphoresis, hypotension, aseptic meningitis, …
How is IV gammaglobulin used as an immunomodulator in rheumatic diseases Read More »