Rituximab for prevention of strokes in cerebral rheumatoid vasculitis

• Published in: Clinical neurology and neurosurgery Vol. 215; p. 107199
• Main Authors: Fana, Michael, Chao, Shing, Katramados, Angelos M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.04.2022; Elsevier Limited
• Subjects: Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - drug therapy; Biopsy; Blood vessels; Cerebral rheumatoid vasculitis; Humans; Immunologic Factors; Immunomodulation; Immunotherapy; Joint diseases; Laboratories; Monoclonal antibodies; Mortality; Patients; Prevention; Remission; Rheumatoid arthritis; Rheumatoid Vasculitis - diagnosis; Rituximab; Rituximab - therapeutic use; Steroid hormones; Steroids; Stroke; Stroke - drug therapy; Stroke - etiology; Stroke - prevention & control; Systemic rheumatoid vasculitis; Vasculitis; Vasculitis, Central Nervous System - complications; Vasculitis, Central Nervous System - drug therapy; Rituximab; Stroke; Systemic rheumatoid vasculitis; Cerebral rheumatoid vasculitis; Rheumatoid arthritis
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2022.107199

Rheumatoid arthritis (RA) is an autoimmune disorder which manifests as inflammation of the synovial joints alongside extra-articular involvement. Uncommonly, patients may develop vasculitis of small and medium-sized blood vessels, formally diagnosed as systemic rheumatoid vasculitis (SRV). In particularly rare cases, patients may develop a subtype of SRV known as cerebral rheumatoid vasculitis (CRV) which manifests in patients as stroke. To date, no formal recommendations or guidelines have been established for treatment and prevention of CRV-induced stroke besides experiential therapy with various immunomodulators. Here, we describe the utility of Rituximab in addition to steroids for prevention of stroke in our patient with evidence of multiple CRV-induced strokes with excellent recovery of post-stroke symptoms and remission of new onset cerebral vasculitis processes. •Cerebral rheumatoid vasculitis is a rare complication of rheumatoid arthritis.•No current treatment guidelines exist for prevention of strokes in CRV.•Rituximab is an efficacious treatment option for prevention of CRV-induced strokes.