Utilize este identificador para referenciar este registo: http://hdl.handle.net/10400.4/1127
Título: Primary biliary cirrhosis in a rheumatoid arthritis patient treated with rituximab, a case-based review
Autor: Polido-Pereira, J
Rodrigues, AM
Canhão, H
Saraiva, F
Pereira da Silva, JA
Fonseca, JE
Palavras-chave: Artrite Reumatóide
Cirrose Biliar Primária
Data: 2011
Editora: Springer
Citação: Clin Rheumatol. 2011 Oct 26. [Epub ahead of print]
Resumo: Primary biliary cirrhosis (PBC) is an autoimmune disease in which intrahepatic bile ducts are targeted by an immune-mediated injury. This disease tends to progress to fibrosis and cirrhosis with hepatic failure. The authors report a case of a 50-year-old rheumatoid arthritis (RA) patient, with erosions and seropositive for rheumatoid factor and anti-citrullinated peptide antibodies, with 18 years disease duration refractory to prednisolone and several disease-modifying antirheumatic drugs, either conventional or biological (adalimumab and etanercept). In April 2007, she started therapy with rituximab (RTX) with good European League Against Rheumatism response achieved 9 months later. In June 2008, she was admitted with intrahepatic cholestasis, steatorrhea, and spontaneous fractures of various ribs. After excluding cholelitiasis, as well as infectious and neoplastic diseases a liver biopsy was performed that was compatible with the diagnosis of PBC. The antinuclear antibodies (1/160) were positive as well as the antimitochondrial antibodies (1/640). Other antibodies were negative such as anti-SSA and anti-SSB. Afterwards, the patient started ursodesoxycholic acid 15 mg kg(-1) day(-1) with progressive improvement of cholestatic markers. A labial salivary gland biopsy was performed and showed findings compatible with the concomitant diagnosis of Sjögren's syndrome. Based on this clinical report, a detailed review of the clinical aspects of PBC is presented as well as its association with other immune-mediated inflammatory diseases, particularly, with RA.
Peer review: yes
URI: http://hdl.handle.net/10400.4/1127
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