Transition of Thyroid Autoantibodies by Rituximab Treatment in Women with Rheumatoid Arthritis

Transition of Thyroid Autoantibodies by Rituximab Treatment in Women

Abstract

Rituximab first used as a treatment for B cell malign lymphoma, is nowadays also used in the treatment of rheumatoid arthritis. On the other hand, an association of rheumatoid arthritis with another autoimmune disease Hashimoto’s Thyroiditis is a a condition that can be expected. Thirty-four-year-old female patient with rheumatoid arthritis, disease-modifying agents were used in various combinations for 9 years. Because of unresponsiveness to treatment, the biological agent rituximab was started. The patient also had euthyroid Hashimoto's Thyroiditis and nodular goiter for 15 years. At the time of the diagnosis of Hashimoto thyroiditis, antiTPO: 45 IU/ml (0-35), antiTg>3000 IU/ml (0-115) but after 4 cycles of treatment with rituximab antiTPO: 7,38 U/ml (0-35), antiTg<10 U/ml (0-115). According to the literature; in patients treated with rituximab for thyroid MALT lymphoma, rheumatoid arthritis, and Grave's disease few of them have been reported to decline in the levels of thyroid autoantibodies.  Levothyroxine replacement dose decreased in some of these patients. The decline of thyroid antibodies with the treatment of rituximab reveals the hope that Hashimoto's Thyroiditis may be treatable. To understand the effect of rituximab treatment on the pathogenesis of Hashimoto's disease further studies involving a large series are required.