Clinical Analysis of 10 Cases of Rituximab Treatment for Refractory Systemic Lupus Erythematosus with Gastrointestinal Involvement

Objective To analyze the clinical efficacy of rituximab (RTX) treatment for systemic lupus erythematosus (SLE) with intestinal involvement by comparing the clinical manifestations, immune indicators, and imaging changes before and after treatment, and to assess its effect on alleviating intestinal damage. Methods The efficacy and adverse reactions of RTX treatment in 10 SLE patients with intestinal involvement, who were hospitalized in the Department of Rheumatology and Immunology at Shanxi Bethune Hospital from January 2015 to January 2024, were analyzed. Results Among the 10 patients, the total disease duration of SLE was 6.2 ± 9.2 years, and the duration of intestinal involvement after SLE diagnosis was 79.2 ± 47.6 months. The time from the onset of intestinal symptoms to the confirmed diagnosis of SLE intestinal involvement was 1.7 (1.0, 7.0) months, and the time from diagnosis of intestinal involvement to the initiation of RTX treatment was 14.1 (1.0, 53.3) months. The follow-up period after RTX treatment was 54.1 ± 27.4 months.The baseline SLE Disease Activity Index 2000 (SLEDAI-2K) for the 10 patients was 21.5 ± 8.08.After receiving RTX (0.5 g on day 1 and day 14) induction therapy, all 10 patients showed complete resolution of intestinal symptoms, significant improvement in clinical symptoms, reduced or disappeared abdominal pain, alleviation or disappearance of gastrointestinal wall thickening and edema, and relief of intestinal obstruction/perforation. Complement C3 and C4 levels improved, IL-6 decreased, absolute B lymphocyte count decreased, SLEDAI score decreased, with a 100% remission rate and a 10% relapse rate.Among these, 3 patients who received high-dose corticosteroid pulse therapy combined with RTX experienced infections. Conclusion Rituximab therapy can effectively improve serum immunological indicators, imaging findings, and intestinal damage in patients with systemic lupus erythematosus (SLE) and intestinal involvement, showing good clinical efficacy.