Changes in cerebral blood flow in rheumatology patients treated with rituximab

Objectives: We aimed to assess the effects of rituximab therapy on cerebral hemodynamics in rheumaticpatients with transcranial Doppler (TCD) ultrasonography.Methods: The study included seven patients aged 20-65 years (2 patients with secondary interstitial lunginvolvement to rheumatoid arthritis, 3 patients with systemic lupus erythematosus and lupus nephritis, 2 patientswith scleroderma and secondary interstitial lung disease) who received rituximab treatment due to rheumaticdiseases. Healthy control group (non-rheumatic group) consisted of seven age and sex-matched, randomlyselected persons did not have risk factors for atherosclerosis. Bilateral middle cerebral artery peak-systolic,end-diastolic, and mean blood flow velocities, Gosling’s pulsatility index values, and Pourcelot’s resistanceindex values were recorded with TCD by a neurosonologist before rituximab administration. Control TCDperformed to the rheumatic group after six months from the last rituximab dosage.Results: One patient was male and six patients were female. Peak-systolic, end-diastolic and mean blood flowvelocities of rheumatic patients were significantly higher than healthy group (p < 0.001). Peak-systolic, enddiastolicand mean blood flow velocities of rheumatic patients were significantly decreased after rituximabtherapy (p < 0.001).Conclusions: This study highlights that the increased cerebral blood flow is indirectly associated withatherosclerosis regarding persistent inflammation in patients with rheumatic diseases. It was thought thattreatment with rituximab could reverse this situation.

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