For patients with scleroderma at high risk of renal crisis, would you feel comfortable giving corticosteroids as pre-medication for rituximab?

I typically will not modify the pre-treatment steroid regimen for Rituxan for scleroderma patients. However, I do assess the patient's risk for scleroderma renal crisis. For example, I consider them high risk if they have early, diffuse scleroderma and particularly if they produce antibodies to RNA polymerase 3. If steroids are needed, for whatever reason, I will ask the patients to aggressively screen for new hypertension at home. If they are high risk, I have them monitor their blood pressure daily. So in the case of pretreatment steroids for Rituxan, I would have them monitor daily around each dose for at least several days.