Rituximab for Behçet's

While I think that (pasterized) milk, dairy and eggs are causing Behçet's, it is interesting to see that Rituximab seems to be helping Behçet's patients.

Rituximab in intractable ocular lesions of Behcet's disease; randomized single-blind control study (pilot study).

Davatchi F, Shams H, Rezaipoor M, Sadeghi-Abdollahi B, Shahram F, Nadji A, Chams-Davatchi C, Akhlaghi M, Faezi T, Naderi N.
Source

Behcet's Unit, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

BACKGROUND:
Ocular lesions, the main morbidity of Behcet's disease (BD), are the most difficult to treat. The aim of this study was to evaluate the efficacy of rituximab.

METHODS:
Inclusion criteria were retinal vasculitis and edema, resistant to cytotoxic drugs. Twenty patients were randomized to a rituximab group (RG) or cytotoxic combination therapy group (CCTG). Rituximab was given in two 1000-mg courses (15-day interval). Subjects received methotrexate (15 mg/weekly) with prednisolone (0.5 mg/kg per day). The CCTG received pulse cyclophosphamide (1000 mg/monthly), azathioprine (2-3 mg/kg per day) and prednisolone (0.5 mg/kg per day). The primary endpoint was the overall state of patients' eyes and the Total Adjusted Disease Activity Index (TADAI). Secondary endpoints were: visual acuity (VA), posterior uveitis (PU), and retinal vasculitis (RV). The baseline data were compared at 6 months by paired sample t-test and analysis of variance.

RESULTS:
TADAI improved significantly in the RG (t = 3.340, P = 0.009), but not in the CCTG (t = 2.241, P = 0.052). For secondary endpoints (RG/CCTG), the mean VA improved in two patients versus three (2/3), remained unchanged in 1/1, and worsened in 7/6 patients. The mean PU improved significantly in the RG (t = 3.943, P = 0.001), not in the CCTG (t = 2.371, P = 0.028). RV improved, but not statistically (t = 2.027, P = 0.057 vs. t = 1.045, P = 0.31). Edema of retina, disc and macula improved significantly in both, but much better for the RG (t = 2.781, P = 0.012 vs. t = 2.707, P = 0.014).

CONCLUSION:
Rituximab was efficient in severe ocular manifestations of BD, TADAI improved significantly after 6 months with rituximab, but not with CCT.

And one more study:

Treatment of retinal vasculitis in Behçet's disease with rituximab.

Sadreddini S, Noshad H, Molaeefard M, Noshad R.

Tabriz University of Medical Sciences, Golgasht St., Tabriz, Iran.

Abstract

Behçet's disease (BD) is more common in eastern than western countries. Physicians have frequently encountered problems in its treatment, especially eye involvement. Recurrent oral and genital aphthous ulcerations are the hallmarks of Behçet's disease but other organs can be involved and ocular disease is one of the most disabling manifestations. Up to now, there are some problems in treatment of the retinal vasculitis due to Behçet's disease. We reported one patient, with visual loss due to retinal vasculitis that was resistant to prednisolone and azathioprine. Our patient was treated successfully with rituximab and his remission was sustained for 24 months of follow-up. Rituximab is a chimeric monoclonal antibody that acts against the specific B cell antigen, CD20. The recent success of rituximab in autoimmune diseases, which is considered to be T cell-mediated, indicates that B cells must have a much broader role in the pathogenesis of autoimmune diseases than generally appreciated.

Behçet's is a rare disease, so very few studies are being done.

However, if you have disease that might be helped by Rituximab, my (slightly educated) guess is to try consume no milk, no dairy and no eggs for at least 4 weeks to see if it helps – it's worth a shot.

Could it be Behçet’s?

Interesting question: Do I have Behçet’s?

With my old diet I had all these following symptoms, (almost) enough to meet the diagnostic criteria for Behçet’s:

• Minor aphthous ulceration [every couple of months in the mouth]
• Pseudofolliculitis [maybe a very very slight, but my follicles were always red]
• Papulopustular lesions [sometimes some]
• Acneiform nodules [not sure, I thought it was acne]
• Extreme exhaustion [Wouldn't call it "extreme", but yes I am quite fatigued]
• Nervous system symptoms [do muscle twitches and migraines count?]

(I am not sure if I might have had a very slight iritis, an inflammation of the iris. My eyecolor changed from green-brown – with brown "patches" – to a more uniform green with slight brown. And the blood veins in the white of my eye got less visible.)

These are the symptoms I had on my old diet, some of which I still have. And some of the symptoms return when I leave the path of the Paleo Diet and venture into my old diet (mainly when I eat pasteurized milk products or when I eat eggs).

And every symptom counts. I really paid not much attention to the aphthous ulcers in my mouth. They came and went again, I could live with them and they were the least of my problems – and why concern myself or even a doctor with such a small thing?

I fear I need go again on my old diet to provoke these symptoms. But not at the moment.

At the moment I am too tired to write more – but is interesting the things one finds.

Eggs – The Other Cause Of Acne?

While I am pretty certain that my acne was caused by dairy (from pasteurized milk), I had some small acne flares from time to time despite not eating any dairy – now I think I narrowed the other cause of acne down to eggs.

And it would make sense, as both milk and eggs contain immunoglobulins. And both pasteurized milk and eggs are heat treated.

One small observation (which I need to confirm yet) is that the acne from eggs is slightly different:

• Eggs seem to cause mainly pustules ("pimples") with round white purulent material, and mainly at what seems to be follicles (e.g. at the arms)
• Dairy from pasteurized milk on the other hand seems to cause mainly inflamed papules/nodules at what seems to be (sweat? sebaceous?) glands (e.g. around the nose)

But same as with acne from milk, it is a "winner takes it all" situtation, with two to three spots and the rest of the skin looking fine.

Situation Normal, All Fucked Up – I guess.