Conclusion
RA patients whose disease did not respond to an initial cycle of rituximab have higher circulating preplasma cell numbers at baseline and incomplete depletion. Our findings indicate that an additional cycle of rituximab administered prior to total B cell repopulation enhances B cell depletion and clinical responses.

“Recently a 45 year old lady with a 10 year history of rheumatoid arthritis, presented to us in congestive cardiac failure. She had no prior cardiac events and was well until a few weeks ago. There was also no other identifiable cardiac risk factors. An echocardiogram showed an ejection fraction of 15%. Her rheumatoid arthritis disease activity was otherwise relatively controlled. “