title: Rituximab and mycophenolate combination therapy in refractory dermatomyositis with multiple autoimmune disorders.
abstract: We report a case of dermatomyositis associated with rheumatoid arthritis, Hashimoto thyroiditis, and diabetes mellitus responsive only to combination of rituximab with mycophenolate. A 42-year-old woman presented with proximal muscle weakness, myalgias, fever, night sweats, and shortness of breath. Creatinine kinase was 8155 IU/L, and muscle biopsy was diagnostic of dermatomyositis. She was started on glucocorticoids; her systemic symptoms improved, but her muscle weakness persisted. She was serially treated with intravenous immunoglobulin, azathioprine, and mycophenolate mofetil without improvement in her weakness. She responded dramatically to combination therapy with rituximab and mycophenolate, with improvement in strength and normalization of creatinine kinase. She has been well controlled on rituximab infusion every 6 months and maintenance mycophenolate mofetil.
authors.affiliation: Department of Neurology, Lahey Clinic, Burlington, MA 01805, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Parziale
authors.forename: Susan C
authors.initials: SC
authors.lastname: Kovacs
authors.forename: Christine B
authors.initials: CB
authors.lastname: Thomas
authors.forename: Jayashri
authors.initials: J
authors.lastname: Srinivasan
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D018501:Antirheumatic Agents / Q000008:administration & dosage; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D001327:Autoimmune Diseases / Q000150:complications* / Q000188:drug therapy*; D003879:Dermatologic Agents / Q000008:administration & dosage; D003882:Dermatomyositis / Q000150:complications* / Q000188:drug therapy*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D050031:Hashimoto Disease / Q000150:complications / Q000188:drug therapy; D006801:Humans; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D003879:Dermatologic Agents; D000069283:Rituximab; D009173:Mycophenolic Acid