Abstracting and Indexing

  • Google Scholar
  • CrossRef
  • WorldCat
  • ResearchGate
  • Academic Keys
  • DRJI
  • Microsoft Academic
  • Academia.edu
  • OpenAIRE

Is Rituximab Therapy Associated with Achilles Tendinopathy?

Article Information

Mallak Zatreh*

Internal medicine, University of Missouri, 2000 Holmes Street, Kansas City, MO 64108, USA

*Corresponding Author: Mallak Zatreh, Internal medicine, University of Missouri, 2000 Holmes Street, Kansas City, MO 64108, USA.

Received: 01 July 2022; Accepted: 12 July 2022; Published: 18 July 2022

Citation: Mallak Zatreh. Is Rituximab Therapy Associated with Achilles Tendinopathy? Journal of Orthopedics and Sports Medicine 4 (2022): 203-204.

View / Download Pdf Share at Facebook

Abstract

Rituximab is a chimeric anti-CD20 monoclonal antibody that is used to treat CD20+ non-Hodgkin's lymphoma, and a wide variety of autoimmune diseases. Rituximab-associated tendinopathy has been described in a few cases in the literature. Here, we present a case of Achilles partial tendon rupture with classic clinical and radiographic findings in a patient treated with rituximab.

Keywords

Rituximab; Achilles Tendinopathy; B cells

Rituximab therapy articles Rituximab therapy Research articles Rituximab therapy review articles Rituximab therapy PubMed articles Rituximab therapy PubMed Central articles Rituximab therapy 2023 articles Rituximab therapy 2024 articles Rituximab therapy Scopus articles Rituximab therapy impact factor journals Rituximab therapy Scopus journals Rituximab therapy PubMed journals Rituximab therapy medical journals Rituximab therapy free journals Rituximab therapy best journals Rituximab therapy top journals Rituximab therapy free medical journals Rituximab therapy famous journals Rituximab therapy Google Scholar indexed journals Drug-induced tendinopathy articles Drug-induced tendinopathy Research articles Drug-induced tendinopathy review articles Drug-induced tendinopathy PubMed articles Drug-induced tendinopathy PubMed Central articles Drug-induced tendinopathy 2023 articles Drug-induced tendinopathy 2024 articles Drug-induced tendinopathy Scopus articles Drug-induced tendinopathy impact factor journals Drug-induced tendinopathy Scopus journals Drug-induced tendinopathy PubMed journals Drug-induced tendinopathy medical journals Drug-induced tendinopathy free journals Drug-induced tendinopathy best journals Drug-induced tendinopathy top journals Drug-induced tendinopathy free medical journals Drug-induced tendinopathy famous journals Drug-induced tendinopathy Google Scholar indexed journals Achilles tendon rupture articles Achilles tendon rupture Research articles Achilles tendon rupture review articles Achilles tendon rupture PubMed articles Achilles tendon rupture PubMed Central articles Achilles tendon rupture 2023 articles Achilles tendon rupture 2024 articles Achilles tendon rupture Scopus articles Achilles tendon rupture impact factor journals Achilles tendon rupture Scopus journals Achilles tendon rupture PubMed journals Achilles tendon rupture medical journals Achilles tendon rupture free journals Achilles tendon rupture best journals Achilles tendon rupture top journals Achilles tendon rupture free medical journals Achilles tendon rupture famous journals Achilles tendon rupture Google Scholar indexed journals Rheumatoid arthritis articles Rheumatoid arthritis Research articles Rheumatoid arthritis review articles Rheumatoid arthritis PubMed articles Rheumatoid arthritis PubMed Central articles Rheumatoid arthritis 2023 articles Rheumatoid arthritis 2024 articles Rheumatoid arthritis Scopus articles Rheumatoid arthritis impact factor journals Rheumatoid arthritis Scopus journals Rheumatoid arthritis PubMed journals Rheumatoid arthritis medical journals Rheumatoid arthritis free journals Rheumatoid arthritis best journals Rheumatoid arthritis top journals Rheumatoid arthritis free medical journals Rheumatoid arthritis famous journals Rheumatoid arthritis Google Scholar indexed journals Deep venous thrombosis articles Deep venous thrombosis Research articles Deep venous thrombosis review articles Deep venous thrombosis PubMed articles Deep venous thrombosis PubMed Central articles Deep venous thrombosis 2023 articles Deep venous thrombosis 2024 articles Deep venous thrombosis Scopus articles Deep venous thrombosis impact factor journals Deep venous thrombosis Scopus journals Deep venous thrombosis PubMed journals Deep venous thrombosis medical journals Deep venous thrombosis free journals Deep venous thrombosis best journals Deep venous thrombosis top journals Deep venous thrombosis free medical journals Deep venous thrombosis famous journals Deep venous thrombosis Google Scholar indexed journals Ankle articles Ankle Research articles Ankle review articles Ankle PubMed articles Ankle PubMed Central articles Ankle 2023 articles Ankle 2024 articles Ankle Scopus articles Ankle impact factor journals Ankle Scopus journals Ankle PubMed journals Ankle medical journals Ankle free journals Ankle best journals Ankle top journals Ankle free medical journals Ankle famous journals Ankle Google Scholar indexed journals Fracture articles Fracture Research articles Fracture review articles Fracture PubMed articles Fracture PubMed Central articles Fracture 2023 articles Fracture 2024 articles Fracture Scopus articles Fracture impact factor journals Fracture Scopus journals Fracture PubMed journals Fracture medical journals Fracture free journals Fracture best journals Fracture top journals Fracture free medical journals Fracture famous journals Fracture Google Scholar indexed journals Orthopedics articles Orthopedics Research articles Orthopedics review articles Orthopedics PubMed articles Orthopedics PubMed Central articles Orthopedics 2023 articles Orthopedics 2024 articles Orthopedics Scopus articles Orthopedics impact factor journals Orthopedics Scopus journals Orthopedics PubMed journals Orthopedics medical journals Orthopedics free journals Orthopedics best journals Orthopedics top journals Orthopedics free medical journals Orthopedics famous journals Orthopedics Google Scholar indexed journals Nonoperative therapy articles Nonoperative therapy Research articles Nonoperative therapy review articles Nonoperative therapy PubMed articles Nonoperative therapy PubMed Central articles Nonoperative therapy 2023 articles Nonoperative therapy 2024 articles Nonoperative therapy Scopus articles Nonoperative therapy impact factor journals Nonoperative therapy Scopus journals Nonoperative therapy PubMed journals Nonoperative therapy medical journals Nonoperative therapy free journals Nonoperative therapy best journals Nonoperative therapy top journals Nonoperative therapy free medical journals Nonoperative therapy famous journals Nonoperative therapy Google Scholar indexed journals Soft tissue articles Soft tissue Research articles Soft tissue review articles Soft tissue PubMed articles Soft tissue PubMed Central articles Soft tissue 2023 articles Soft tissue 2024 articles Soft tissue Scopus articles Soft tissue impact factor journals Soft tissue Scopus journals Soft tissue PubMed journals Soft tissue medical journals Soft tissue free journals Soft tissue best journals Soft tissue top journals Soft tissue free medical journals Soft tissue famous journals Soft tissue Google Scholar indexed journals Lymphoma articles Lymphoma Research articles Lymphoma review articles Lymphoma PubMed articles Lymphoma PubMed Central articles Lymphoma 2023 articles Lymphoma 2024 articles Lymphoma Scopus articles Lymphoma impact factor journals Lymphoma Scopus journals Lymphoma PubMed journals Lymphoma medical journals Lymphoma free journals Lymphoma best journals Lymphoma top journals Lymphoma free medical journals Lymphoma famous journals Lymphoma Google Scholar indexed journals Leukemia articles Leukemia Research articles Leukemia review articles Leukemia PubMed articles Leukemia PubMed Central articles Leukemia 2023 articles Leukemia 2024 articles Leukemia Scopus articles Leukemia impact factor journals Leukemia Scopus journals Leukemia PubMed journals Leukemia medical journals Leukemia free journals Leukemia best journals Leukemia top journals Leukemia free medical journals Leukemia famous journals Leukemia Google Scholar indexed journals Granulomatosis articles Granulomatosis Research articles Granulomatosis review articles Granulomatosis PubMed articles Granulomatosis PubMed Central articles Granulomatosis 2023 articles Granulomatosis 2024 articles Granulomatosis Scopus articles Granulomatosis impact factor journals Granulomatosis Scopus journals Granulomatosis PubMed journals Granulomatosis medical journals Granulomatosis free journals Granulomatosis best journals Granulomatosis top journals Granulomatosis free medical journals Granulomatosis famous journals Granulomatosis Google Scholar indexed journals Polyarticular arthritis articles Polyarticular arthritis Research articles Polyarticular arthritis review articles Polyarticular arthritis PubMed articles Polyarticular arthritis PubMed Central articles Polyarticular arthritis 2023 articles Polyarticular arthritis 2024 articles Polyarticular arthritis Scopus articles Polyarticular arthritis impact factor journals Polyarticular arthritis Scopus journals Polyarticular arthritis PubMed journals Polyarticular arthritis medical journals Polyarticular arthritis free journals Polyarticular arthritis best journals Polyarticular arthritis top journals Polyarticular arthritis free medical journals Polyarticular arthritis famous journals Polyarticular arthritis Google Scholar indexed journals Heart failure articles Heart failure Research articles Heart failure review articles Heart failure PubMed articles Heart failure PubMed Central articles Heart failure 2023 articles Heart failure 2024 articles Heart failure Scopus articles Heart failure impact factor journals Heart failure Scopus journals Heart failure PubMed journals Heart failure medical journals Heart failure free journals Heart failure best journals Heart failure top journals Heart failure free medical journals Heart failure famous journals Heart failure Google Scholar indexed journals

Article Details

1. Introduction

Rituximab is a chimeric monoclonal antibody that binds to the CD20 surface marker expressed on B cells. This includes precursor B cells (pre-B cells) and mature and memory B cells. It was originally used to treat lymphoma but is increasingly used for the treatment of autoimmune diseases. Drug-induced tendinopathy has most commonly been associated with fluoroquinolones, statins, glucocorticoids, and aromatase inhibitors. Rituximab-induced tendinitis and tendon rupture has been described in a case series of 3 patients for the first time [1]. Investigations are needed to see whether use of Rituximab is associated with occurrence of Achilles tendon rupture. Herein, we describe a 63-year-old male patient who developed a nontraumatic Achilles Tendon rupture after receiving Rituximab therapy.

2. Case report

63-year-old African American male with a past medical history of Rheumatoid Arthritis and recent diagnosis of IgG-4 related lung disease for which he was started on Rituximab therapy. Patient was sent to the emergency department from his Primary Care Physician (PCP) office for concern of right leg Deep Venous Thrombosis (DVT). Patient presented to his PCP for his follow up visit. Patient’s main complaint was right ankle/distal calf pain that started 12 days prior to his presentation and 6 days after his second Rituximab therapy. Patient reports that 12 days prior to his presentation, as he was raising up from a kneeling position, he experienced a pop in the right calf. He notes immediate onset of pain and swelling over the right ankle. States he has been able to walk since the incident but notes he has been trying to keep his leg straight and has not attempted to put weight on the ball of his right foot. Additionally, he reports significant bruising over the calf that started on same day of incident. Denies any numbness or tingling in the right lower extremity. For concern of DVT, he was sent to the ED. Right lower extremity examination revealed edema and ecchymosis over the posterior distal calf overlying the Achilles tendon. Tenderness to palpation and partial defect palpable along the Achilles tendon cord of the posterior ankle. Patient was unable to perform single leg heel raise while standing due to pain. Plantar flexion noted with Thompson test, although less in comparison to the contralateral extremity. He was able to actively dorsiflex/plantarflex the ankle with decreased strength of plantarflexion (Ankle plantar flexion 4/5 compared to contralateral side). Sensibility presents to light touch in the sural/saphenous/tibial/superficial peroneal/deep peroneal distributions. 2+ Dorsal Pedis and Posterior Tibialis pulses. Brisk capillary refill was present distally. An X-ray of right ankle was done and demonstrated no acute fracture or dislocation but showed an area within the posterior heel concerning for partial discontinuity of the Achilles tendon (Figure 1). A clinical diagnosis of partial Achilles tendon rupture was rendered. No Magnetic Resonance Imaging (MRI) was performed. The risks, benefits, and alternatives of operative versus nonoperative management for his partial Achilles tendon rupture was discussed with the patient by the orthopedics team and mutual decision was reached to pursue a trial of nonoperative therapy. His right foot was placed into a short leg splint in a position of comfort with slight plantar flexion to allow for soft tissue rest and was made non-weight- bearing. At 2 week follow up, he was placed in a Controlled Ankle Movement (CAM) boot and was advanced to full weight-bearing as tolerated. At 6 week follow up, the CAM boot was removed, and he managed to walk without issues. The patient had regained total range of motion of the ankle with no tenderness at the Achilles tendon.

fortune-biomass-feedstock

Figure 1: X-ray of right ankle showing irregularity of the anterior margin of the Achilles tendon with fat stranding involving Kager's triangle.

3. Discussion

Rituximab has been proved effectively in treating malignant and autoimmune disease such as lymphoma, leukemia, rheumatoid arthritis, granulomatosis with polyangiitis and microscopic polyangiitis [2-4]. Rituximab is a genetically engineered chimeric murine/human monoclonal IgG1 kappa antibody directed against the CD20 antigen [5]. Several adverse effects have been identified including but not limited to pancytopenia, uveitis, serum sickness, polyarticular arthritis, heart failure, bowel obstruction, interstitial lung disease and Posterior Reversible Encephalopathy Syndrome (PRES) [6-10]. To date, there have been only a few cases of Rituximab associated Achilles tendon rupture reported in literature [1]. Our case highlights a potential association between Rituximab and Achilles tendinopathy/rupture since the symptoms started 6 days after he received the second Rituximab infusion suggesting a potential cause-effect relationship.

4. Conclusion

Rituximab is widely used in management of lymphomas and a wide variety of autoimmune diseases. Achilles tendinopathy and rupture is a potential complication. Randomized controlled studies are needed to establish a causal relationship. In conclusion, the presentation of this case study has highlighted the potential role for routine MRI scanning to assess Achilles tendon ruptures and identification of risk for a second rupture. In conclusion, the presentation of this case study has highlighted the potential role for routine MRI scanning to assess Achilles tendon ruptures and identification of risk for a second rupture.

References

  1. Alqahtani A, Sabha M, Abdelfattah T, et al. Tendonitis and tendon rupture after treatment with rituximab: a case series. Am J Ther 24 (2017): e592-e595.
  2. Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 346 (2002): 235-242.
  3. Shaw T, Quan J, Totoritis MC. B cell therapy for rheumatoid arthritis: the rituximab (anti-CD20) experience. Ann Rheum Dis 62 (2003): ii55-59.
  4. Randall KL. Rituximab in autoimmune diseases. Aust Prescr 39 (2016): 131-134.
  5. Smith MR. Rituximab (monoclonal anti-CD20 antibody): mechanisms of action and resistance. Oncogene 22 (2003): 7359-7368.
  6. Lioté H, Lioté F, Séroussi B, et al. Rituximab-induced lung disease: A systematic literature review. Eur Respir J 35 (2010): 681-687.
  7. Karmacharya P, Poudel DR, Pathak R, et al. Rituximab-induced serum sickness: A systematic review. Semin Arthritis Rheum 45 (2015): 334-340.
  8. Verdesca SVS, Villani C, Rossini M, et al. [Posterior Reversible Encephalopathy Syndrome (PRES) induced by Rituximab in two patients with vasculitis, and treated by hemodialysis]. G Ital Nefrol 35 (2018).
  9. Cheungpasitporn W, Kopecky SL, Specks U, et al. Non-ischemic cardiomyopathy after rituximab treatment for membranous nephropathy. J Renal Inj Prev 6 (2016): 18-25.
  10. Adashek M, Chan A, Medina A. Gastrointestinal perforation after rituximab therapy in mantle cell lymphoma: a case report. Case Rep Oncol 11 (2018): 784-790.

Journal Statistics

Impact Factor: * 3.667

CiteScore: 2.9

Acceptance Rate: 11.01%

Time to first decision: 10.4 days

Time from article received to acceptance: 2-3 weeks

Discover More: Recent Articles

Grant Support Articles

© 2016-2024, Copyrights Fortune Journals. All Rights Reserved!