BACKGROUND
Ankylosing spondylitis (AS) is a chronic inflammatory disease that predominantly affects the axial skeleton. The ability of anti-TNF-α agents to reduce disease activity in patients with
axial spondyloarthritis (
axSpA), including AS, has been demonstrated in multiple randomized trials and several meta-analyses. Reports on the efficacy of
rituximab in treatment of AS have described good results. We report on a patient with AS who failed anti-TNF-α
therapy but showed good clinical improvement with
rituximab therapy. CASE REPORT A 38-year-old male patient was diagnosed with AS and showed poor response to
sulfasalazine and non-steroidal anti-inflammatory drugs (
NSAIDs).
Infliximab was initiated with marked improvement as per the Bath
ankylosing spondylitis disease activity index (BASDAI). Due to disease flare, the patient was switched to
etanercept. He subsequently acquired
papillary thyroid cancer and
etanercept was discontinued. He underwent a total
thyroidectomy followed by radioiodine
therapy. For his ongoing active disease,
NSAIDs and
sulfasalazine were resumed with a lack of response (BASDAI=7.1).
Rituximab was started and resulted in significant improvement (BASDAI=2.3). CONCLUSIONS
Rituximab can be a potential target
therapy for patients who start to lose response to
TNF-inhibitors or for those who develop solid
malignancies. Further placebo-controlled studies are required.