Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody (rituximab)

Rheumatology (Oxford). 2011 Aug;50(8):1390-4. doi: 10.1093/rheumatology/ker107. Epub 2011 Mar 4.


Objective: Rituximab (RTX), a chimeric mAb directed against the B-cell marker CD20, was investigated for its anti-inflammatory effect in treating refractory uveitis associated with JIA.

Methods: Case series, retrospective multicentre. JIA patients with severe uveitis with vision-threatening complications (n = 10) and with insidious onset. All patients were treated with RTX for active uveitis refractory to topical and systemic CSs, immunosuppressives and at least one of the TNF-α inhibitors. All had active arthritis. Uveitis and arthritis course were assessed before and after RTX treatment.

Results: After one RTX cycle (mean follow-up 11 months, range 7-18 months), uveitis inactivity was achieved in seven oligoarthritis patients (ANA⁺, HLA-B27⁻) for a prolonged period of time (mean 7.5 months, range 6-9 months). Therefore, CSs and immunosuppression could be spared. In three of four patients responding to RTX, uveitis recurred thereafter, and RTX re-treatment led to inactivity again. In another three patients (ANA⁺ polyarthritis, n = 1; ANA⁺ HLA-B27⁺ oligo- or polyarthritis, n = 2) uveitis activity persisted after RTX therapy. In seven patients, arthritis improved or was inactive after RTX treatment (PedACR30/50/70).

Conclusion: RTX may represent a rescue therapy option for severe JIA-associated uveitis refractory to CSs, immunosuppression and TNF-α inhibitors.

Publication types

  • Case Reports
  • Multicenter Study

MeSH terms

  • Adolescent
  • Antibodies, Monoclonal, Murine-Derived / therapeutic use*
  • Arthritis, Juvenile / complications
  • Arthritis, Juvenile / diagnosis
  • Arthritis, Juvenile / drug therapy*
  • Child
  • Drug Resistance / drug effects
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Retrospective Studies
  • Rituximab
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • Uveitis, Anterior / complications
  • Uveitis, Anterior / diagnosis
  • Uveitis, Anterior / drug therapy*
  • Young Adult


  • Antibodies, Monoclonal, Murine-Derived
  • Glucocorticoids
  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha
  • Rituximab