A rare association of rheumatoid arthritis and primary biliary cirrhosis treated with rituximab: a case report

INTRODUCTION: Primary biliary cirrhosis is an autoimmune disease that tends to progress to fibrosis and cirrhosis with hepatic failure. Primary biliary cirrhosis is often associated with other non- hepatic autoimmune diseases. An association with rheumatoid arthritis has been suggested to coexist in 1.8% to 5.6% of patients with primary biliary cirrhosis, but data supporting this association are scarce. The etiologic and pathogenetic mechanisms are not yet fully understood and several factors have been implicated. The therapeutic management must consider the two pathologies. CASE PRESENTATION: We describe the case of a 60-year-old Moroccan woman with severe erosive rheumatoid arthritis and primary biliary cirrhosis treated with rituximab. During treatment, we observed a good clinical and biological response of her rheumatoid arthritis but persistent abnormal liver function tests. CONCLUSION: B cells seem to play a major role in the pathogenesis of both rheumatoid arthritis and primary biliary cirrhosis. Additional studies are necessary to better determine the therapeutic role of rituximab in both diseases.