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Introduction. The cases of reactivation of chronic HBV hepatitis were described in rheumatology and then in hematology. Usually, HBV relapses are described after the third cure of biological therapy in both rheumatologic and hematologic pathology. Purpose. The assessment and monitoring of developments in the treatment of a woman with chronic HBV reactivated after biologic therapy with Rituximab for a small B-cell non-Hodgkin's lymphoma who developed also chronic kidney disease. Results. We present the case of a 36 years old woman with reactivation of chronic HBV hepatitis after biological therapy with Rituximab (cure 9) for non Hodgkin's lymphoma with small B-cell. We initiate lamivudine therapy for one month; thereafter we continue with entecavir (dose adjusted to the glomerular filtration rate), together with Rituximab, with favorable outcome both in hematological pathology, as well as in chronic HBV hepatitis, respectively in the biochemical and virology response. Conclusions. In our case, the patient followed the trend of most cases described in the literature, with return to normal ALT values and viral negativity, but without HBs seroconversion. [ABSTRACT FROM AUTHOR]

Reports on healing of erosions in rheumatoid arthritis (RA) are rare. Biological disease modifying antirheumatic drugs can halt the structural progression and even introduce the repair of damaged joints in a portion of patients with RA. We present a case of RA patient who achieved clinical, functional, structural remission and presented repair of damaged joints. [ABSTRACT FROM AUTHOR]

Introduction. The cases of reactivation of chronic HBV hepatitis are described in rheumatology and then in hematology. Usually, HBV relapses are described after the third cure of biological therapy in both rheumatologic and hematologic pathology. Our purpose was the assessment and monitoring of developments in the treatment of a patient with chronic HBV reactivated after biologic therapy with rituximab for small B-cell non-Hodgkin's lymphoma. Case presentation. We present the case of a 36 years old patient with reactivation of chronic HBV hepatitis after biological therapy with rituximab (cure 9) for non Hodgkin's lymphoma with small B-cell. We initiate lamivudine therapy for one month; thereafter we continue with entecavir, together with rituximab, with favorable outcome both in hematological pathology, as well as in chronic HBV hepatitis, respectively in the biochemical and virology response. Conclusions. In our case, the patient followed the trend of most cases described in the literature, with return to normal ALT values and viral negativity, but without HBs seroconversion. [ABSTRACT FROM AUTHOR]

Introduction. Rituximab (RTX), an anti-CD20 monoclonal antibody, tested in randomised placebo-controlled trials and approved for clinical practice, has demonstrated its efficacy in rheumatoid arthritis (RA) in patients with TNFa inhibitor failure. Objectives. The present study aims to monitor the evolution of a group of RA patients, undergoing RTX treatment over a 12 month period. The main objective was to assess the parameters of disease activity throughout RTX treatment at 6, respectively 12 months. The secondary objectives were to evaluate the therapeutic response to RTX contingent on the classic disease modifying drug associated and the body mass index. Materials and method. The present article is a descriptive retrospective case-series study, which included a group of 30 patients with RA treated with RTX. Treatment efficacy was evaluated with the aid of ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), VAS (visual analog scale), SJC (swollen joint count), TJC (tender joint count) and the composite score DAS28 at three different time points: treatment initiation, 6 months and 12 months. For data analysis, the present study used Microsoft Excel 2010 and SPSS Statistics 20. The statistical tests employed for the analysis were: the paired t-test, the independent t-test and the Chi-squared test. Results. In the study group the mean DAS28 decreases from 5,62 at treatment initiation to 3,96 at 6 months, reaching 3,09 at the end of the study period. These values display a decrease in linear time trend (R2 = 0,9157) and their differences are statistically significant when taking the obtained p-values into account. The individual components of DAS28 display the same trend. At 12 months, the RTX-leflunomide (LEF) patient subgroup displayed statistically significant lower means for DAS28 and ESR in comparison to the association RTX-methotrexate (2,67 vs. 3,28, p = 0,038); (16,22 mm/h vs. 28,04 mm/h, p = 0,011); moreover, a higher proportion of the first group reached LDA at 6 months (44,4% vs 0%, p = 0,001) and at 12 months (55,6% vs 9,5%, p = 0,006). At the end of the study period, the patient subgroup with a normal BMI exhibited lower ESR values (20,13mm/h vs 28,86mm/h, p = 0,045), DAS28 scores (2,82 vs 3,37, p = 0,042), more marked improvement in the DAS28 score from baseline (3,02 vs 2, p = 0,022) and a higher proportion of remission (40% vs 0%, p = 0,006) in comparison to overweight patients. Conclusions. For the study group it has been shown that all the parameters of disease activity decrease from baseline at 6 months and, respectively, 12 months. It has also been shown that the RTX-LEF association is superior to the RTX-methotrexate one and that patients with a normal BMI have better treatment response rates. [ABSTRACT FROM AUTHOR]

Although rheumatoid arthritis has a high incidence of hematological malignacy, the association with chronic lymphocitic leukemia is not that frequent, especially the secretory subtype. The next case presents this extremely rare association, discussing the ethiopathogeny, the diagnosis and the therapeutic option; as far as we know, it is the first case report in literature to present a case of rheumatoid arthritis and chronic lymphocitic leukemia that receives rituximab for both conditions. [ABSTRACT FROM AUTHOR]

Background. The Rheumatoid Arthritis (RA) is a disease with chronic evolution and often leads to severe joints deterioration and functional impairment. It may associate comorbidities and disabilities which dramatically lower patients' quality of life, thus having also an important social and economic impact. In the past decade, biologic therapies considerably changed RA treatment but a significant percentage of patients have an inadequate response after initial cures with TNF inhibitors. Therefore, finding better therapeutic approaches becomes imperative. Objective. Evaluation of clinical efficacy of Rituximab, in patients with severe active RA and with inadequate response to initial anti-TNF therapy, in routine clinical practice in Romania. Material and Methods. In this open-label, multicentre, prospective observational study, patients were treated with initial (2 x 1000 mg IV, at 2 weeks apart) and subsequent RTX courses at 6 months interval. Clinical assessment included 28-joint disease activity score (DAS-28), simple disease activity index (SDAI) and clinical disease activity index (CDAI), plus delta DAS-28, delta SDAI and delta CDAI between two consecutive evaluations. The assessed was done at baseline, and after each retreatment course at 6, 12, 18 and 24 months. The analysis was performed using unpaired t-tests and Pearson correlation coefficients R2 in regression analysis. Disease activity states (remission, moderate, low and high activity) were assessed with cut-off points for each of the three scores using Cuzick non-parametric trend tests across ordered groups. Statistical analyses were performed with STATA SE 11.0 software. Results. A total of 943 adult (> 18 years) patients with active RA and inadequate response to at least one TNF inhibitor received initial RTX treatment. Median clinical scores steadily decreased after each retreatment: DAS-28 was initially 5.67 and reached 2.80 after 24 months, SDAI varied similarly from 27.68 to 4.44, while CDAI from 26 to 3.80. In DAS-28, initial remission rate of 4.67% progressively increased after each retreatment course to 10.95% (n = 877), 18.79% (n = 580), 35.1% (n = 302) and 39.83% (n = 118), whereas initial proportion of patients showing high disease activity (63.94%) steadily decreased to 16.65%, 3.62%, 1.66% and 0.85% at 6, 12, 18 and 24 months, respectively. Similar trends were observed in SDAI and CDAI scores. Conclusions. Our results after the first 2 years of the REPEAT clinical trial show a high efficacy of the RTX therapy for patients having experienced failure of the anti-TNF cure. In addition occurs a consolidation of the clinical response after each consecutive cure regardless of the assessment tool used, the remission rate after 2 years after the switch to RTX being impressive. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis is a chronic systemic inflammatory disease affecting the joints in association with the presence of systemic manifestations.Being a disease with high destructive potential, the treatment optimization for each patient is needed to obtain the therapeutic outcomes. We present the case of a 45 years old patient whose suffering started at 28 years and after several treatment regimens reached a complete remission of the disease. We will discuss laboratory tests, positive diagnosis and therapeutic attitude that led to the treatment optimization of this patient. [ABSTRACT FROM AUTHOR]

Objectives. We conducted a retrospective observational study to compare infusion related adverse events (IRAE) among patients with RA undergoing biological therapy with infliximab or rituximab under follow-up at the Clinic of Rheumatology in Cluj-Napoca Methods. We evaluated 133 patients who were administered at least one infusion of the biological therapy. Infusion reactions were defined as acute, if occurring during or within 24 h after the infusion, and as delayed if occuring 24 h to 14 days after administration. IRAE rates were calculatedfor each therapy. Results. 87 patients under IFX (first or second line therapy) and 46 patient under rituximab (indication after anti-TNF failure) were evaluated. All patients received concomitant immunosuppressive therapy (DMARD - disease modifying antirheumatic drug), premedication with corticosteroids was administered only in the RTX group. 21 (15.8%) RA patients experienced an IRAE. Among the infliximab group, adverse event were recorded in 12.8% of patients. IRAE incidence was 1.2% (17/1425 infusions) in the IFX group and 0.96% (4/416 infusions) in the RTX group. Although IRAE incidence was higher for IFX than RTX, the difference was not statistically significant (p=0.12). Most IRAE were mild. Delayed reactions - were recorded in three cases (14.2%). No IRAE were fatal. Conclusion. The incidence of IRAE in RA patients treated with IFX and RTX is low. Most infusion related adverse events occur within thefirst 24 h. Premedication with corticosteroids and maintenance therapy with DMARDs appears to play an important role in preventing IRAE. We have not found a correlation between immunological profile, disease activity and severity of these events. A close monitoring of the disease and patients allowed changing the therapeutic regimen to achieve the desired maximum effect and avoid fatal events. [ABSTRACT FROM AUTHOR]

Objectives. We conducted a retrospective observational study to compare infusion related adverse events (IRAE) among patients with RA undergoing biological therapy with infliximab or rituximab under follow-up at the Clinic of Rheumatology in Cluj-Napoca Methods. We evaluated 133 patients who were administered at least one infusion of the biological therapy. Infusion reactions were defined as acute, if occurring during or within 24 h after the infusion, and as delayed if occuring 24 h to 14 days after administration. IRAE rates were calculated for each therapy. Results. 87 patients under IFX (first or second line therapy) and 46 patient under rituximab (indication after anti-TNF failure) were evaluated. All patients received concomitant immunosuppressive therapy (DMARD - disease modifying antirheumatic drug), premedication with corticosteroids was administered only in the RTX group. 21 (15.8%) RA patients experienced an IRAE. Among the infliximab group, adverse event were recorded in 12.8% of patients. IRAE incidence was 1.2% (17/1425 infusions) in the IFX group and 0.96% (4/416 infusions) in the RTX group. Although IRAE incidence was higher for IFX than RTX, the difference was not statistically significant (p=0.12). Most IRAE were mild. Delayed reactions - were recorded in three cases (14.2%). No IRAE were fatal. Conclusion. The incidence of IRAE in RA patients treated with IFX and RTX is low. Most infusion related adverse events occur within the first 24 h. Premedication with corticosteroids and maintenance therapy with DMARDs appears to play an important role in preventing IRAE. We have not found a correlation between immunological profile, disease activity and severity of these events. A close monitoring of the disease and patients allowed changing the therapeutic regimen to achieve the desired maximum effect and avoid fatal events. [ABSTRACT FROM AUTHOR]

Background: rheumatoid arthritis (RA) is a systemic inflammatory disease with an unknown etiology and an autoimmune pathogenesis characterized by a deforming and destructive arthritis, but with multiple systemic manifestations. Nowadays, there is a trend in treating earlier and more aggressive RA taken into account the highly intense and erosive forms of disease. Aims: to assess the efficacy and safety of Rituximab (RTX) associated with Methotrexate (MTX) in patients with active RA that had an inadequate response to one or more anti TNFα therapy. Material and method: this study included 57 patients aged between 23 and 77 years old, diagnosed with RA according to the ACR 1987 criteria, admitted in a rheumatology service clinic from Bucharest from April 2008 to August 2011. Results: selected patients have a mean age of 54.5±12.9 years, 49 women, with a mean disease duration of 12.07±6.2 years, 85.9% had positive rheumatoid factor and 57.9% were positive for anti CCP antibodies. The response to the treatment with RTX, evaluated periodically after initiation through DAS28 score, is not influenced by the prior TNFα inhibitor, nor by the number of prior TNFα agents used. Conclusion: choosing the treatment with RTX as an alternative to patients with RA that have had an inadequate response to anti TNFα therapy represents one of the most appropriate method of optimizing the treatment of these patients. [ABSTRACT FROM AUTHOR]

Extranodal malignant lymphomas are rare and more difficult to diagnose than nodal lymphomas. Thyroid primary lymphoma is extremely rare, but its evolution after chemotherapy + radiotherapy or surgery is often favourable. We present the case of a female patient diagnosed with non- Hodgkin's malignant lymphoma of marginal zone, extranodal, mucosal associated lymphatic tissue type, based on histopathological and immunohistochemical exam of resected thyroid. The evolution under chemotherapy + rituximab was favourable, as afterwards. [ABSTRACT FROM AUTHOR]