Severe Headache in Primary Sjögren's Syndrome Responded to Rituximab.
Rituximab
headache
primary Sjögren’s syndrome
Journal
European journal of case reports in internal medicine
ISSN: 2284-2594
Titre abrégé: Eur J Case Rep Intern Med
Pays: Italy
ID NLM: 101648453
Informations de publication
Date de publication:
2023
2023
Historique:
received:
05
08
2023
accepted:
16
08
2023
medline:
4
10
2023
pubmed:
4
10
2023
entrez:
4
10
2023
Statut:
epublish
Résumé
Primary Sjögren syndrome (pSS) is an immune systemic disease, that may affect the central nervous system. A severe headache unresponsive to treatment is the headache which is persistently nonresponsive to narcotic analgesics. A 48-year-old woman with a 10-year history of pSS was seen in January 2021, complaining of a headache one week previously. The headache was characterised by a dull persistent pressing intensity and was not responding to paracetamol, NSAIDs or codeine. She had no previous history, nor family history. Physical examination revealed bilateral parotid glands enlargement. Laboratory tests showed anaemia, and elevated levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), with positive anti-La and anti-Ro antibodies. She was given topical treatment and different doses of Predlone, in addition to methotrexate10 mg/week. She had received three pulses of methylprednisolone and was started on azathioprine with a mild response to the headaches, so she received two initial IV doses of rituximab 375 mg/m Headache that may presented in pSS are tension headaches, migraines and cluster headaches. The therapy is disease-modifying antirheumatic drugs, hydroxychloroquine, glucocorticoids and biotherapeutics. Rituximab is used in the treatment of some patients with pSS, especially where it can affect systemic symptoms. Rituximab treatment may be an option for severe headache in patients with pSS. The mechanism is unknown but may be due to depletion of brain auto-reactive B cells. Further research is needed. An unresponsive headache in a patient with primary Sjögren's syndrome treated with tryptophan, opioids and NSAIDs responded successfully to B-cell depletion with rituximab.We hypothesise that brain-autoreactive B cells were involved in the pathogenesis of the headache.
Identifiants
pubmed: 37789982
doi: 10.12890/2023_004051
pii: 4051
pmc: PMC10545156
doi:
Types de publication
Journal Article
Langues
eng
Pagination
004051Informations de copyright
© EFIM 2023.
Déclaration de conflit d'intérêts
Conflicts of Interests: The Authors declare that there are no competing interests.
Références
Ann Rheum Dis. 2007 Mar;66(3):351-7
pubmed: 16950808
Front Immunol. 2023 Feb 02;14:1127417
pubmed: 36817420
Curr Treat Options Neurol. 2022;24(1):17-40
pubmed: 35317303
Ann Med Surg (Lond). 2023 Jun 5;85(7):3381-3385
pubmed: 37427219
Ann Med Surg (Lond). 2022 Jul 31;80:104243
pubmed: 36045773
Ann Rheum Dis. 1989 Apr;48(4):312-6
pubmed: 2712611
Acta Neurol Scand. 2008 Sep;118(3):189-92
pubmed: 18355394
J Neuroinflammation. 2021 Nov 8;18(1):259
pubmed: 34749743
Front Immunol. 2016 Oct 25;7:451
pubmed: 27826298
Clin Case Rep. 2019 Jan 17;7(3):416-418
pubmed: 30899462
Clin Immunol. 2017 Sep;182:62-71
pubmed: 28478105
Nat Rev Immunol. 2009 Dec;9(12):845-57
pubmed: 19935804
Ann Rheum Dis. 2017 Jan;76(1):9-16
pubmed: 27789466
PLoS One. 2014 Jan 20;9(1):e84605
pubmed: 24465419
Front Pharmacol. 2021 Sep 02;12:731122
pubmed: 34539411
J Rheumatol. 2014 Nov;41(11):2214-22
pubmed: 25274895