immunoglobulin (Fovepta / Zutectra / Hepatect)

Mycophenolate mofetil as salvage therapy for refractory acute-onset CIDP associated with rheumatoid arthritis: a case report.

Tan Jinhui J, Huang Hai H, Tan Linghua L, Li Bo B

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated neuropathy that rarely co-occurs with rheumatoid arthritis (RA). When CIDP proves refractory to first-line therapies, management becomes particularly challenging, especially in patients with multiple autoimmune conditions. A 43-year-old Chinese male with a 3-year history of seropositive RA in sustained remission presented with acute progressive quadriparesis, bilateral ptosis, and facial diplegia. Cerebrospinal fluid analysis revealed albuminocytologic dissociation, and nerve conduction studies demonstrated evolving demyelinating features, consistent with a diagnosis of acute-onset CIDP (A-CIDP). The patient responded inadequately to sequential treatment with intravenous immunoglobulin, high-dose corticosteroids, and the neonatal Fc receptor (FcRn) antagonist efgartigimod, experiencing repeated relapses during corticosteroid tapering. Mycophenolate mofetil (MMF) was subsequently introduced as a steroid-sparing agent at 0.75 g twice daily, enabling further prednisone tapering from 20 mg to 10 mg daily without relapse; MMF was later up-titrated to 1 g twice daily. Under a combined, multi-target immunosuppressive regimen of MMF, prednisone, methotrexate, iguratimod, and hydroxychloroquine, the patient achieved sustained neurological improvement, with prednisone successfully tapered to 10 mg daily by October 2025 and maintained thereafter. By April 2026, only residual mild ptosis persisted, and no infectious complications occurred. This case suggests that MMF-based multi-target immunosuppression may be a therapeutic option for RA-associated, treatment-refractory A-CIDP, potentially enabling successful glucocorticoid tapering even after an inadequate response to a short course of FcRn-targeted therapy.

Efficacy and safety of acupuncture therapy for chronic spontaneous urticaria: a network meta-analysis based on randomized controlled trials.

Chang Mingde M, Wu Linna L, Wang Zhao Z, Wang Yurou Y et al.

Chronic spontaneous urticaria (CSU) is a common refractory skin disorder impairing quality of life. This study systematically evaluated the clinical efficacy and safety of acupuncture therapies for CSU, providing evidence for clinical decision-making. Eight databases-CNKI, VIP, WanFang, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science-were searched from their inception to 31 July 2025, for randomized controlled trials (RCTs) investigating various acupuncture therapies for CSU. The quality of the included studies was assessed using the Risk of Bias 2 tool. Data analysis was performed using R4.4.2 and Stata 18. This study was registered in PROSPERO (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024608056). Ninety-three RCTs involving 7,746 patients were included. Based on surface under the cumulative ranking curve (SUCRA) analysis, acupuncture combined with autohemotherapy ranked first in improving efficacy [SUCRA = 92.79%, relative risk (RR) = 1.46, 95% credible interval (CrI): 1.19, 1.84]. Moxibustion ranked first in reducing the Dermatology Life Quality Index (DLQI) score [SUCRA = 99.94%, mean difference (MD) = -9.45, 95% CrI: -12.48, -6.44]. In terms of wheal count, most pairwise comparisons among interventions showed no significant differences, and none of the acupuncture therapies demonstrated statistical superiority over antihistamines. Acupuncture combined with moxibustion ranked first in reducing the severity of pruritus (SUCRA = 96.27%, MD = -1.03, 95% CrI: -1.15, -0.91). Autohemotherapy combined with moxibustion ranked first in reducing the levels of immunoglobulin E (IgE) (SUCRA = 93.05%, MD = -36.23, 95% CrI: -55.33, -17.33). The combination of acupuncture, bloodletting puncture and cupping (BLP-C), and antihistamine ranked first in both reducing interleukin-4 (SUCRA = 97.95%, MD = -194.39, 95% CrI: -317.68, -71.10) and increasing IFN-γ (SUCRA = 99.78%, MD = 32.36, 95% CrI: 19.00, 46.49). Acupuncture combined with cupping therapy ranked first in reducing the incidence of adverse reactions (SUCRA = 91.69%, RR = 0.04, 95% CrI: 0.04, 0.24) and relapse rate (SUCRA = 91.79%, RR = 0.02, 95% CrI: 0, 0.09). Acupuncture therapies demonstrate good efficacy and safety in treating CSU. Nevertheless, optimal interventions should be selected based on the characteristics of symptoms, immune profiles, and patient tolerability. These findings should be interpreted cautiously and validated in larger, higher-quality trials due to study limitations. identifier CRD42024608056.

Immunoglobulin deposition and plasma cell infiltration define distinct immunopathological patterns in skin diseases.

Ogawa-Momohara Mariko M, Ozawa Yukihiro Y, Yamashita Yuta Y

Immunoglobulin deposition in the skin is an important diagnostic and etiological feature in many skin diseases. However, the relationship between deposited immunoglobulins and the local presence of antibody-producing cells, such as B cells and plasma cells, remains poorly understood. In several autoimmune diseases, including systemic lupus erythematosus and bullous pemphigoid, marked immunoglobulin deposition is observed despite limited B-cell infiltration into the skin, suggesting that the deposited antibodies primarily originate as circulating autoantibodies. In contrast, diseases such as discoid lupus erythematosus are characterized by progressive B-cell infiltration, the formation of ectopic lymphoid tissue, and increased local antibody production within the skin. In other diseases, including dermatomyositis, a mismatch is observed between circulating autoantibodies and the subclasses of deposited immunoglobulins, suggesting the possibility of local immunoglobulin production independent of systemic reactions. In several inflammatory skin diseases, such as scleroderma, hidradenitis suppurativa, and syphilis, marked plasma cell infiltration is observed from the early stages of the disease, despite weak or irregular immunoglobulin deposition. These findings suggest that plasma cells in the skin have functions other than antibody production and may contribute to disease pathogenesis through cytokine production, immune regulation, and interaction with local tissues.

Localised immunoglobulin light chain amyloidosis of the rectum: a rare endoscopic finding.

Laurijssen Annebelle Liselotte AL, Cruijsen Marjan M, van Lijnschoten Ineke I, Schreuder Ramon-Michel RM