• DOI:10.1093/RHEUMATOLOGY/KEL274
• Corpus ID: 33948574

Physiotherapy management of non-specific back and neck pain.

@article{Sweetman2006PhysiotherapyMO,
  title={Physiotherapy management of non-specific back and neck pain.},
  author={Brian J. Sweetman},
  journal={Rheumatology},
  year={2006},
  volume={45 11},
  pages={
          1451-2
        }
}

• B. Sweetman
• Published 1 November 2006
• Medicine
• Rheumatology

matoid vasculitis typically involves treatment with medications that can cause significant immunosuppression. In this case, the patient was unable to take methotrexate or leflunomide due to pre-existing liver fibrosis. He developed severe immunosuppression in response to various other DMARD agents, and biological agents including anti-tumour necrosis factor (TNF) therapy were ineffective for synovitis; therefore when he developed vasculitis it was decided to give a trial of B-cell depletion therapy with rituximab. Rituximab has been well-tolerated in rheumatoid arthritis in the trials to date, but there is limited information on retreatment of patients [1, 5, 6]. In a recent study by Leandro et al. [7], there were 15 patients described who were retreated, but the time between treatments was longer (median of 20 months) than for our patient, and the dose of rituximab given (1000mg 2 weeks apart) was different than in our patient. The patient described above has thus far tolerated repeated courses of rituximab and has not demonstrated any serious side effects or immunosuppression. In this case, repeated courses of rituximab without concomitant methotrexate or cytoxan proved to be a viable, well-tolerated alternative for treatment of severe rheumatoid arthritis with vasculitis in a patient who had serious side effects from other conventional DMARD treatments.