Year 2018, Volume 4 , Issue 4, Pages 362 - 365 2018-10-04

Changes in cerebral blood flow in rheumatology patients treated with rituximab

Uygar Utku [1] , Gözde Çetin [2] , Nurhan Atilla [3]


Objective: We aimed to assess the effects of rituximab therapy on cerebral hemodynamics  in rheumatic patients with transcranial Doppler (TCD) ultrasonography. 

Methods: The study included seven patients aged 20-65 years (2 patients with secondary interstitial lung involvement to rheumatoid arthritis, 3 patients with systemic lupus erythematosus and lupus nephritis, 2 patients with scleroderma and secondary interstitial lung disease) who received rituximab treatment due to rheumatic diseases. Healthy control group (non-rheumatic group) consisted of seven age and sex-matched, randomly selected persons did not have risk factors for atherosclerosis. Bilateral middle cerebral artery peak-systolic, end-diastolic, and mean blood flow velocities, Gosling’s pulsatility index values, and Pourcelot’s resistance index values were recorded with TCD by a neurosonologist before rituximab administration. Control TCD performed to the rheumatic group after six months from the last rituximab dosage. 

Results: One patient was male and six patients were female. Peak-systolic, end-diastolic and mean blood flow velocities of rheumatic patients were significantly higher than healthy group (p < 0.001). Peak-systolic, end-diastolic and mean blood flow velocities of rheumatic patients were significantly decreased after rituximab therapy (p < 0.001).

Conclusions: This study highlights that the increased cerebral blood flow is indirectly associated with atherosclerosis regarding persistent inflammation in patients with rheumatic diseases. It was thought that treatment with rituximab could reverse this situation. 

Rituximab, inflammation, atherosclerosis, cerebral blood flow
  • [1] Ross R. Atherosclerosis -- an inflammatory disease. N Engl J Med 1999;340:115-26.
  • [2] Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 2002;105:1135-43.
  • [3] Selmi C, Generali E, Massarotti M, Bianchi G, Sciré CA. New treatments for inflammatory rheumatic disease. Immunol Res 2014;60:277-88.
  • [4] Yüksel S, Ayvazyan L, Gasparyan AY. Familial mediterranean fever as an emerging clinical model of atherogenesis associated with low-grade inflammation. Open Cardiovasc Med J 2010;23:4:51-6.
  • [5] Lin CW, Huang YP, Chiu YH, Ho YT, Pan SL. Increased risk of ischemic stroke in young patients with ankylosing spondylitis: a population-based longitudinal follow-up study. PloS One 2014;9:e94027.
  • [6] Kerekes G, Soltesz P, Der H, Veres K, Szabo Z, Vegvari A, et al. Effects of biologics on vascular function and atherosclerosis associated with rheumatoid arthritis. Ann N Y Acad Sci 2009;1173:814-21.
  • [7] Szekanecz Z, Kerekes G, Soltesz P. Vascular effects of biologic agents in RA and spondyloarthropathies. Nat Rev Rheumatol 2009;5:677-84.
  • [8] Provan SA, Berg IJ, Hammer HB, Mathiessen A, Kvien TK, Semb AG. The impact of newer biological disease modifying anti-rheumatic drugs on cardiovascular risk factors: a 12-month longitudinal study in rheumatoid arthritis patients treated with rituximab, abatacept and tociliziumab. PloS One 2015;10:e0130709.
  • [9] Mathieu S, Pereira B, Dubost JJ, Lusson JR, Soubrier M. No significant changes in arterial stiffness in RA after 6 months and 1 year of rituximab treatment. Rheumatology (Oxford) 2012;51:1107-11.
  • [10] de Riva N., Budohoski KP, Smielewski P, Kasprowicz M, Zweifel C, Steiner LA, et al. Transcranial Doppler pulsatility index: what it is and what it isn’t. Neurocrit Care 2012;17:58-66.
  • [11] Bos MJ, Koudstaal PJ, Hofman A, Witteman JC, Breteler MM. Transcranial Doppler hemodynamic parameters and risk of stroke: the Rotterdam study. Stroke 2007;38:2453-8.
Primary Language en
Subjects Health Care Sciences and Services
Journal Section Original Articles
Authors

Orcid: 0000-0003-1280-4754
Author: Uygar Utku
Institution: Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Neurology, Kahramanmaras
Country: Turkey


Orcid: 0000-0001-9680-7535
Author: Gözde Çetin
Institution: Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Rheumatology
Country: Turkey


Orcid: 0000-0003-4127-4924
Author: Nurhan Atilla
Institution: Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Pulmonology, Kahramanmaras
Country: Turkey


Dates

Publication Date : October 4, 2018

EndNote %0 The European Research Journal Changes in cerebral blood flow in rheumatology patients treated with rituximab %A Uygar Utku , Gözde Çetin , Nurhan Atilla %T Changes in cerebral blood flow in rheumatology patients treated with rituximab %D 2018 %J The European Research Journal %P -2149-3189 %V 4 %N 4 %R doi: 10.18621/eurj.346321 %U 10.18621/eurj.346321