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Nat. Rev. Rheumatol. doi:10.1038/nrrheum.2016.18 Figure 3 The effects of repeated rituximab infusions on anti-dsDNA antibody levels in a patient with SLE Figure 3 | The effects of repeated rituximab infusions on anti-dsDNA antibody levels in a patient with SLE. This patient presented at age 26 years with fevers, arthritis and serositis, and was diagnosed with systemic lupus erythematosus (SLE). She was positive for antinuclear antibodies, antibodies to double-stranded DNA (anti-dsDNA antibodies), antiribonucleoprotein antibodies and anti-Ro antibodies. She failed to respond to conventional treatment with azathioprine, hydroxychloroquine and methotrexate, and went on to develop lupus nephritis. Increasing disease activity led to the commencement of cyclophosphamide and rituximab therapy. Despite several cycles of rituximab over a 5-year period she progressed to end-stage renal failure. Her anti-dsDNA antibody levels showed a stepwise increase after almost every rituximab infusion, despite low numbers of B cells. B-cell numbers are indicated by CD19 levels. Rituximab treatments are indicated by arrows. Ehrenstein, M. R. & Wing, C. (2016) The BAFFling effects of rituximab in lupus: danger ahead? Nat. Rev. Rheumatol. doi:10.1038/nrrheum.2016.18