Rituximab for treatment of scleritis associated with rheumatoid arthritis

Biological agents for the treatment of uveitis

“…Rituximab has been used for the treatment of systemic antineutrophil cytoplasmic antibody-positive (ANCA+) vasculitis associated with Wegener's granulomatosis [142,143]. Huang and Foster (personal communication) previously at the Massachusetts Eye and Ear Infirmary have used intravenous rituximab successfully for a Wegener's granulomatosis patient with associated scleritis, retinal vasculitis and panuveitis, refractory to traditional immunosuppressive agents [144,145]. Rituximab may represent a rescue therapy option for severe juvenile idiopathic arthritis-associated uveitis refractory to Churg--Strauss syndrome (CSS), immunosuppression and TNF-a inhibitors [146].…”

Rituximab Therapy for Refractory Idiopathic Scleritis

“…3 Two case reports showed a similar benefit of rituximab (two 1-g infusions separated by 14 days) in RA-associated scleritis. 4,5 One of these patients was also taking oral methotrexate, and both showed remission of their condition lasting more than 6 months. 5 With the latter regime, a favorable response was obtained in 2 patients with GPA-associated scleritis.…”

“…9 Interestingly, in patients with RA, GPA, and pSS complicated with scleritis, the administration of rituximab, either as monotherapy or in combination with corticosteroids or immunosuppressive agents, has specifically shown a favorable outcome of the eye involvement. [3][4][5][6][7] In these patients, rituximab has been administered using either the lymphoma dose regime (consisting of 4 weekly infusions of 375 mg/m 2 ) or the RA approach (2 infusions of 1 g separated by 14 days). Irrespective of its particular cause, scleritis pathogenesis involves local vasculitis.…”

“…Rituximab has proven to be successful in the resolution of systemic autoimmune diseases presenting with scleritis. [3][4][5][6][7] Its action results in an increased susceptibility to opportunistic infections. 8 More frequently, rituximab is associated with infusion reactions.…”

Can Rituximab Induce Long-Term Disease Remission in Patients with Intra-Ocular Non-Infectious Inflammation?

“…While these studies demonstrated rituximab is effective for treating scleritis, a recent study has suggested rituximab has limited response in patients with refractory scleritis and orbital inflammation, possibly due to fibrotic changes in the orbit [50]. Results among patients with scleritis associated with rheumatoid arthritis have been reported where use of rituximab resulted in disease remission and systemic steroids and immunosuppressive agents were discontinued [51,52]. …”