Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody (rituximab)

Objective. Rituximab (RTX), a chimeric mAb directed against the B-cell marker CD20, was investigated for its anti-inflammatory effect in treating refractory uveitis associated with JIA. Methods. Case series, retrospective multicentre. JIA patients with severe uveitis with vision-threatening complications (n = 10) and with insidious onset. All patients were treated with RTX for active uveitis refractory to topical and systemic CSs, immunosuppressives and at least one of the TNF-a inhibitors. All had active arthritis. Uveitis and arthritis course were assessed before and after RTX treatment. Results. After one RTX cycle (mean follow-up 11 months, range 718 months), uveitis inactivity was achieved in seven oligoarthritis patients (ANA + , HLA-B27) for a prolonged period of time (mean 7.5 months, range 69 months). Therefore, CSs and immunosuppression could be spared. In three of four patients responding to RTX, uveitis recurred thereafter, and RTX re-treatment led to inactivity again. In another three patients (ANA + polyarthritis, n = 1; ANA + HLA-B27 + oligo- or polyarthritis, n = 2) uveitis activity persisted after RTX therapy. In seven patients, arthritis improved or was inactive after RTX treatment (PedACR30/50/70). Conclusion. RTX may represent a rescue therapy option for severe JIA-associated uveitis refractory to