gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Refractory scleritis in primary Sjögren syndrome: successful treatment with Rituximab

Meeting Abstract

  • corresponding author B. Nölle - Klinik für Ophthalmologie, UKSH Campus Kiel
  • K. Ahmadi-Simab - Klinische Rheumatologie, UKSH Campus Lübeck und Rheumaklinik Bad Bramstedt
  • P. Lamprecht - Klinische Rheumatologie, UKSH Campus Lübeck und Rheumaklinik Bad Bramstedt
  • W.L. Gross - Klinische Rheumatologie, UKSH Campus Lübeck und Rheumaklinik Bad Bramstedt

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogP 217

The electronic version of this article is the complete one and can be found online at:

Published: September 22, 2004

© 2004 Nölle et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




In primary Sjögrens-syndrome (PSS) T cell mediated autoimmunity plays a significant role in immunopathogenesis. However, B cell mediated immunity in addition has been shown important. Therefore, a B cell directed immunosuppression seems reasonable in treatment resistant cases.

Case report

A 60-year-old woman suffered from PSS with keratoconjunctivitis sicca, chronic anterior scleritis and arthralgia. She needed systemic corticosteroids (> 30mg/d) and various other immunosuppressants (methotrexate 20mg/week i.v., cyclosporine A 5mg/kg/d p.o., cyclophosphamide 2mg/kg/d p.o., intravenous immunoglobulins 0.4g/kg, TNF-α inhibitor infliximab 5mg/kg i.v., leflunomide 20mg/d p.o.). These substances were applied in various combinations within 2 years without induction of remission of scleritis. After a 4 week interruption of that treatment, still under 50mg/d prednisolone, infusion with Mabthera© (Rituximab, anti-CD20 chimaeric, monoclonal antibody, 375mg/m2) was given. The patient got four cycles of rituximab infusions at a four week interval. The scleritis disappeared with improvement of sicca-symptoms and arthralgia. Corticosteroids could be reduced to 5mg/d. FACS-analysis of peripheral lymphocytes showed a depletion of CD-20 positive B cells. Meanwhile maintenance of remission is performed with mycophenolic acid/mofetil (2g/d).


B lymphocyte cell depletion with rituximab seems a new treatment option in refractory scleritis due to Sjögrens syndrome. It seems reasonable to test this treatment strategy in more patients.