Concerns regarding quality of life should be addressed: impairment of function at school, work, or in personal relationships; social and emotional support; financial resources; and adequacy of patient education regarding their disease (13). Anxiety and major depression are more prevalent in patients with IBD than in the general population, and these conditions are more pronounced in patients with greater ongoing disease activity (72, 73). Besides providing indication for specific therapies, these psychiatric diagnoses may also predict the likelihood for medication noncompliance, a frequent contributing factor to poorer clinical outcomes and greater health-care costs (74–76).
Data from a small prospective study support the use of rituximab (in combination with IV immune globulin) in patients with pemphigus vulgaris that was refractory to multiple lines of therapy, including systemic corticosteroids and with minimal response to IV immune globulin alone [Ahmed 2006] . Clinical experience and data from retrospective studies also suggest the utility of rituximab in the management of refractory pemphigus vulgaris [Cholera 2016] , [El Tal 2006] , [Kasperkiewicz 2011] . Additional data may be necessary to further define the role of rituximab in this condition.