Low-Dose Rituximab in Lupus Enteritis: A Comparative Study on Its Efficacy in Modulating Mucosal Immunity and Reducing Inflammation

This study aimed to compare the efficacy and safety of rituximab (RTX) combined with glucocorticoids versus conventional immunosuppressive therapy in patients with lupus enteritis (LE). A total of 36 patients with LE were enrolled, including 16 who received RTX plus glucocorticoids and 20 who received conventional immunosuppressants. Within six months of treatment, the RTX group showed significant improvement or resolution in abdominal pain (P = 0.01), gastrointestinal wall thickening and edema (P = 0.021), and mesenteric exudation (P = 0.014). A significant reduction in maximal gastrointestinal wall thickness was also observed (P < 0.001). RTX treatment significantly reduced SLEDAI-2K scores (P < 0.05), corrected hypocomplementemia (C3 and C4), lowered ESR levels (P < 0.05), and decreased serum immunoglobulin A (IgA) levels (P < 0.05). Notably, serum IL-6 levels were markedly reduced (P < 0.05). At three months, the RTX group exhibited significantly lower SLEDAI scores compared to the control group (P < 0.05). The remission rate in the RTX group was 93.75%, which was not statistically different from the conventional therapy group (85%, P = 0.418). The incidence of infections did not differ significantly between the two groups (P = 0.926). These findings suggest that low-dose rituximab is effective and well-tolerated in patients with moderate-to-severe lupus enteritis. Improvements in imaging features, serum and fecal IgA, and IL-6 levels indicate that RTX may modulate mucosal immunity and reduce intestinal inflammation. Further validation in large-scale randomized controlled trials is warranted.