Tags: scleroderma | treatment

How Should I Treat My Scleroderma?

By    |   Friday, 06 February 2015 11:03 AM

Question: My doctor thinks I may have scleroderma and he wants me to take rituximab which supposedly is for people whose arthritis has been unaffected by regular medicine. But I'm not taking anything for arthritis and have never been formally diagnosed with scleroderma. I had Graves' disease and have thyroid eye disease. It is unclear what benefit rituximab will be to me. What should I do?

Dr. Hibberd’s answer: 
Rituximab is a monoclonal antibody therapy against the protein CD20 — and is a form of immunotherapy. CD20 protein is found on the surface of immune system B cells. It is used to treat conditions with B cell excess, overactivity, or dysfunction.

The treatment indications include a wide variety of disorders from cancers of our white blood cells such as lymphoma and leukemia to autoimmune disorders such as rheumatoid arthritis. It is not without side effects, and even with severe RA, it is approved for use in combination with methotrexate for those who have failed to respond to one or several therapies.

There are many off-label uses — multiple sclerosis and other autoimmune disorders and for management of kidney transplant patients — but there is no specific indication for scleroderma or Graves’ disease that I know of. This said, there are published studies that “demonstrate improvement of skin fibrosis and prevention of worsening lung fibrosis, supporting the therapeutic concept of B cell inhibition in [scleroderma].”

So perhaps your doctor is on to something here.
I would strongly suggest you get a second opinion from a rheumatologist at an academic medical center close to you. You need to have your diagnosis clarified first, then address the various options available to you as the next step.

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It's a good idea to get at least two opinions on the best way to treat scleroderma.
scleroderma, treatment
Friday, 06 February 2015 11:03 AM
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