Refinement of a sonographic protocol for assessment of haemophilic arthropathy

et al. [5] described one patient successfully treated with rituximab after several months of ineffective conventional immunosuppressive treatment. They also discussed two previously described cases treated with rituximab, after having failed on several therapeutic regimens. In the three cases in this study, the inhibitors were eradicated with rituximab at 7 months, 3 weeks and 10 months, respectively. Our first patient was treated before the availability of rituximab and has received many months of immunosuppressive treatments with their potential associated risks. Each one of our three other patients treated with rituximab had a quick and successful evolution with inhibitor less than 0.6 BU at day 17, 13 and 14, respectively, after the first dose of rituximab, without evidence of side effect. These three patients were also given prednisone and/or IVIG as initial therapy. It is difficult to attribute the success of treatment of these three patients only to rituximab. Reported clinical experience with this condition indicates that the usual time of response with prednisone is much longer than that observed in our patients. In conclusion, we consider that rituximab is an effective and safe treatment for postpartum acquired haemophilia. Given the apparent lack of side effects with rituximab compared with that of prolonged corticosteroid and/or immunosuppressive agents, rituximab, alone or in association with concomitant corticotherapy, could be considered as first line treatment for this condition.