Abstract
IntroductionPrimary biliary cirrhosis is an autoimmune disease that tends to progress to fibrosis and cirrhosis with hepatic failure. Primary biliary cirrhosis is often associated with other non- hepatic autoimmune diseases. An association with rheumatoid arthritis has been suggested to coexist in 1.8% to 5.6% of patients with primary biliary cirrhosis, but data supporting this association are scarce. The etiologic and pathogenetic mechanisms are not yet fully understood and several factors have been implicated. The therapeutic management must consider the two pathologies.Case presentationWe describe the case of a 60-year-old Moroccan woman with severe erosive rheumatoid arthritis and primary biliary cirrhosis treated with rituximab. During treatment, we observed a good clinical and biological response of her rheumatoid arthritis but persistent abnormal liver function tests.ConclusionB cells seem to play a major role in the pathogenesis of both rheumatoid arthritis and primary biliary cirrhosis. Additional studies are necessary to better determine the therapeutic role of rituximab in both diseases.
Highlights
Primary biliary cirrhosis is an autoimmune disease that tends to progress to fibrosis and cirrhosis with hepatic failure
Case presentation: We describe the case of a 60-year-old Moroccan woman with severe erosive rheumatoid arthritis and primary biliary cirrhosis treated with rituximab
B cells seem to play a major role in the pathogenesis of both rheumatoid arthritis and primary biliary cirrhosis
Summary
Primary biliary cirrhosis (PBC) is an autoimmune disease characterized by chronic destruction of bile ducts that can lead to liver cirrhosis. The association of PBC with rheumatoid arthritis (RA) is exceptional, and the true prevalence of PBC in RA is not well known [4] This may impose several therapeutic and diagnostic challenges. Laboratory tests showed that our patient had an inflammatory syndrome with an erythrocyte sedimentation rate of 81mm at the first hour and a C-reactive protein level of 14mg/L Her rheumatoid factor was positive at 143IU/L, and she had an anti-citrullinated protein antibody level of 798UI/mL. Radiographs showed erosions of her metacarpophalangeal and metatarsophalangeal joints, bilateral carpus and tarsus, atlantoaxial dislocation, and left coxitis Based on this clinical, biological and radiological evidence, a diagnosis of active and severe RA was made. Our patient was treated with a low dose of methotrexate (MTX; 7.5mg/week) associated with rituximab (two doses of 1000mg separated by two weeks), which demonstrated good efficiency in her arthritis after five months of follow-up (Disease Activity score-28 of 2.8), but her abnormal liver function tests persisted
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