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Open Access

Class switched memory B cells are enriched in the synovium after rituximab treatment

  • Burkhard Möller1,
  • Istvan Vajtai1,
  • Sabine Adler1,
  • Stefan Eggli1,
  • Hans-Rudolf Ziswiler1,
  • Clemens Dahinden1 and
  • Peter M Villiger1
Arthritis Research & Therapy20079(Suppl 3):P24

Published: 19 October 2007


ArthritisJuvenile Idiopathic ArthritisSynovial TissueJoint ReplacementInflammatory Activity

A 49-year-old female was diagnosed with polyarticular, rheumatoid factor-positive juvenile idiopathic arthritis at the age of 15. Advanced destruction required bilateral knee joint replacement 8 years later. Persistent inflammatory activity led to rituximab treatment (1,000 mg on days 1 and 15) in an advanced disease stage. Peripheral blood analyses showed immediate B-cell depletion. Synovial tissue histology 8 months later in the early reconstitution phase revealed scattered follicular-like infiltrates including CD20+ B cells. Flow cytometry of homogenized tissue showed CD19+ B cells predominantly representing an IgD-CD27+ class switched memory phenotype, which was contrasted by >90% IgD+CD27- peripheral blood B cells. This observation, which indicates either local persistence or early B-cell repopulation and a composition of synovial B cells discordant to peripheral blood, could have an impact on the future development of monitoring strategies after rituximab treatment in arthritis.

Authors’ Affiliations

Inselspital – University Hospital Bern, Department for Rheumatology and Clinical Immunology, Bern, Switzerland


© BioMed Central Ltd 2007