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1
Rituximab has transformed rheumatoid arthritis treatment but shows a 40% non-response rate, highlighting limitations in B-cell depletion strategies.
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2
Therapeutic resistance to rituximab arises from CD20-negative plasmablasts, mutated B-cell receptors, and loss of regulatory B cells.
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3
Recent studies reveal B cells have protective roles, producing tolerogenic antibodies and regulating inflammation, challenging their solely pathogenic view.
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4
Updated EULAR and ACR guidelines refine rituximab's use for high-risk patients, particularly those with interstitial lung disease or recent malignancies.
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5
CD19 CAR-T cell therapy represents a paradigm shift, offering potential for drug-free remission by deeply resetting the immune system in refractory RA.
