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A prospective open-label trial of rituximab (RTX) for IgG4-related disease (IgG4-RD) was recently described in the Annals of the Rheumatic Diseases by Carruthers et al.1 According to their results, RTX is effective as induction therapy for IgG4-RD without glucocorticoid in the short term. We agree and support their results. We have also prescribed RTX for typical cases of IgG4-RD, showing characteristics of younger age, experience of several relapses, no history of hepatitis B and, since 2011, hesitation to increase the dose of glucocorticoid due to complications. We are currently treating three cases using RTX. Our protocol is as follows. We prescribe 500 mg/body of RTX at the onset of relapse. Meanwhile, the dose of glucocorticoid is decreased as much as possible. The patients visit our hospital for blood tests once every few months. Whole-body CT is routinely performed once a year. When relapse is suspected, we examine the whole body by CT.The maximum period of follow-up since initial RTX is currently 4 years. Case 1 involved a 60-year-old Japanese woman. She presented with IgG4-related dacryoadenitis and sialadenitis, and autoimmune pancreatitis. The initial dose of glucocorticoid was 40 mg/day, but relapses repeated with the tapering of steroid doses. Immunosuppressants were added, but proved ineffective and a third relapse was experienced in 2011. RTX

We examined the antibodies against Helicobacter pylori proteins in the cerebrospinal fluid (CSF) of 7 patients with Guillain-Barré syndrome (GBS). Crude H. pylori antigens, fractionated heat shock protein (HSP), and urease B (UB) from H. pylori antigens were separated by SDS-PAGE. With Western blot analysis, four of seven CSF samples had several IgG antibodies against H. pylori proteins, including HSP and UB. No cross reactivity against Campylobacter jejuni was observed. These antibodies may be involved in the immune responses of patients with GBS.

Helicobacter pylori is a major etiologic agent in gastroduodenal disorders. In this study, immunoglobulin A (IgA) antibodies to H. pylori were estimated in serum and gastric juice specimens from patients with gastritis and peptic ulcers using antibody capture enzyme-linked immunosorbent assays (ACELISAs). The antibody titers of the ACELISAs are independent of the antibody concentration and reflect the ratio of H. pylori-specific IgA to total IgA. The ratio is stable, although the antibody concentration fluctuates in gastric juice. Using the ACELISAs it was possible to evaluate quantitatively not only serum IgA (SR-IgA) antibodies but also secretory IgA (SC-IgA) antibodies in gastric juice. There were significant differences between the patients and control group in the SR-IgA and SC-IgA ACELISAs. Furthermore, the ACELISAs made it possible to compare between SR-IgA antibodies in serum and SC-IgA antibodies in gastric juice. In all patients, the ratios of H. pylori-specific IgA were higher in gastric juice than in serum. These results suggest that H. pylori SC-IgA antibodies are mainly produced by the local immune response in the gastric mucosa. Our studies indicate that ACELISA is well suited for the analysis of local immune response in mucosa.

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