Hydroxychloroquine (HCQ), a drug used to treat many diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), has limited reports documenting drug-induced myopathies as a side effect. This entity is underdiagnosed with unclear treatment interventions apart from discontinuing the offending drug. We report a case of a biopsy-proven hydroxychloroquine-induced myopathy in a 35-year-old female patient with SLE. The offending drug was stopped, but the patient did not improve. However, she showed marked improvement after the use of intravenous immunoglobulin (IVIG).
AIMS AND OBJECTIVES: Current knowledge of patients' preferences for rheumatoid arthritis (RA) treatment is limited. Our goal was to determine the most favorable mode of therapy and the reasons behind choosing each route among RA patients in the Rheumatoid Arthritis Saudi Database (RASD). MATERIALS AND METHODS: In this cross-sectional, nationwide, qualitative study, we conducted interviews with 308 RA patients to assess their preferred mode of therapy (oral, subcutaneous (SC) injection, or intravenous (IV) infusion) and to determine the reasons behind their choice. The determining factors behind patients' preferred mode of therapy were evaluated using a 10-point allocation system (1 = least important, 10 = most important). RESULTS: We interviewed 308 RA patients (83.4% females, mean age, 48 years). Among all administration modes, the oral route was identified as the most preferred mode among our patients, with a percentage of 73.3%, followed by SC injection and IV infusion at 19.5% and 7.3%, respectively. Ease of drug administration was the most reported reason for patients who chose the oral route over the injection route (63.2%). Difficulty remembering to take the drug and finding it hard to swallow the pills were the highest-scored reasons for avoiding the oral route (24.9%). CONCLUSION: Our study demonstrates and emphasizes the importance of shared decision-making between patients and their physicians. The oral route of therapy is, by far, the most preferred mode among our cohort of RA patients.
Introduction/Objectives: This rapid evidence assessment (REA) was conducted to assess the burden of weight-bearing joint osteoarthritis in the developing countries of Africa and the Middle East. Methods: Our REA methodology used a standardized search strategy to identify observational studies, published between January 1, 2010, and April 23, 2020, reporting on outcomes pertaining to the epidemiology and humanistic or economic burden of weight-bearing osteoarthritis. Relevant data from the included studies were used for qualitative analysis. Results: Among the 20 publications reporting on knee osteoarthritis in 10 countries in Africa and the Middle East, 2 also reported on hip, and 1 on foot osteoarthritis. Prevalence of symptomatic/radiographic knee OA was 9-14% among rheumatology outpatients and 31-34% among those with mixed etiology osteoarthritis. Prevalence of knee OA diagnosed by magnetic resonance imaging was 70% among patients ≥40 years of age attending a hospital in Saudi Arabia. Quality-of-life outcomes were reported in 16 publications and suggested a substantial humanistic burden of osteoarthritis, including worse pain, function, and quality of life, and more depression; comparisons between studies were hampered by the variety of tools and scoring scales used, however. No studies reported on economic outcomes. Conclusion: This REA indicates a substantial burden of osteoarthritis in weight-bearing joints in Africa and the Middle East, consistent with publications from other regions of the world.
Background and Objectives: Early diagnosis and treatment is associated with improved outcomes in patients with systemic lupus erythematosus (SLE). Studying the journey of SLE patients in Saudi Arabia is essential to direct future health-care plans. Patients and Methods: This is a cross-sectional, multicenter study. Eligibility criteria included a diagnosis of SLE that was confirmed by a rheumatologist. Patients younger than 18 at the time of interview were excluded. Primary objectives were to determine time from first symptoms to initial physician visit (Lag 1), time from initial physician visit to encounter with rheumatologist (Lag 2), time from first visit to a rheumatologist to diagnosis of SLE (Lag 3), and time from diagnosis to start of treatment (Lag 4). Secondary objectives were to determine the number and specialty of physicians seen by patients, the speciality type that confirmed the diagnosis, first symptoms experienced, and age at first diagnosis of SLE. Results: Three hundred patients (92.3% women) with SLE were evaluated. Mean age at diagnosis was 29.92 years. Mean disease duration was 8.1 years. The majority were college educated (43.0%). The most common initial symptom was joint pain (68%), followed by skin rash (23%), and fever (3.7%). Lag 1 was less than one month in 68.2% of patients. Lag 2 was less than one month in 33.4% of patients and exceeded one year in 25.8%. Lag 3 was less than 1 month in 68.7% of patients. Lag 4 was less than one month in 94.4% of patients. The diagnosis of SLE was made most frequently by rheumatologists (80%). Evaluation by primary care, orthopedic and dermatology physicians were associated with delays in diagnosis. Conclusion: Delay was marked in Lag 2. Causes of delay included evaluation by non-specialists and visiting higher numbers of physicians before diagnosis confirmation.
Infections of the paranasal sinuses are common and usually occur in patients who are immunocompromised. Many atypical clinical presentations have been reported but rarely in the elderly population. We report a 71-year-old female patient with a 20-year history of an autoimmune disease who had recently become resistant to treatment. Her autoimmune symptoms significantly improved following resection of deeply seated bacterial infection in her paranasal sinuses. She was also diagnosed with cervical cancer. Clinicians should look carefully for hidden infections and/or malignancies in patients lacking response while on immunosuppressive therapy for autoimmune disease.
One of the most prevalent causes of vasculitis is bacterial infection. An infection that causes anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is uncommon and not reported frequently. We report a case of a 74-year-old male who presented with fever for ten days and was found to have brucellosis. Then, he was diagnosed with Guillain-Barré syndrome (GBS) and started on immunoglobulin (IVIG) for one week without a response. His fever was still persistent despite appropriate antibiotic therapy. Rheumatology evaluation revealed a history of multiple joint pain and swelling, elevated inflammatory marker, and a high titer of P-ANCA. Steroid therapy was started initially on the background of antibiotics therapy. His fever and other symptoms showed marked improvement after one week. However, P-ANCA titer was still elevated. The decision was made to treat the patient as a case of brucellosis-induced P-ANCA vasculitis. Azathioprine was added, and steroid was maintained for one month and then it was tapered gradually. All symptoms improved from the third month of follow-up except weakness from peripheral neuropathy with normalization of P-ANCA titer. His condition remained stable after six months of follow-up. Clinicians should be aware of the possibility of infection-induced vasculitis, particularly when patients' symptoms persist despite the appropriate use of antibiotics.
INTRODUCTION: Osteoporosis (OP) is one of the most common comorbidities associated with rheumatoid arthritis (RA). Literatures reported that the risk for developing OP was strongly associated with duration and severity of RA. We aim to elaborate on the consequences of OP on disease activity and management plan in patients with RA. PATIENTS AND METHODS: A retrospective cohort study recruited 408 patients, including those with RA alone and with RA plus OP. The RA disease activity in the patients was assessed using disease activity score in 28 joints (DAS28-CRP). A statistical analysis was performed to compare data between the two groups of patients and determine any significant risk factor associated with the development of OP in RA patients. RESULTS: Of 408 patients who were included in this study, 353 patients (86.5%) had only RA, while 55 patients (13.5%) had RA with OP and showed significant difference (P = 0.04) concerning age categories. Patients diagnosed with RA and OP had RA duration longer than RA-only patients (independent t-test, P = 0.01). The two groups had almost similar disease activity at the three clinical visits, as well, had nearly similar disability at their first visit, whereas RA with OP patients had significant greater disability at their 2nd and 3rd visits (independent t-test, P = 0.001). Both groups were treated with the same biologic and non-biologic medication of similar frequency, although RA patients with OP received steroid more frequently than patients had RA only (61.7% vs. 41.7%, chi square test, P = 0.03). CONCLUSION: There was no significant difference in disease activity at both groups of patients. However, RA with OP group had longer duration of RA, were more frequently treated with steroids, and had greater disability. We recommend physicians focus on controlling RA disease activity, early screening for and treating of OP.
Vitamin D is proposed to have a potential role in the pathogenicity, clinical presentation, prognosis, complications, and treatment of several diseases. In addition to its well-known role in calcium metabolism, vitamin D regulates both innate and adaptive immunity, and subsequently modulates the antiviral and antibacterial inflammatory immune responses. In view of the emerging coronavirus disease 2019 (COVID-19) pandemic, searching for potential therapeutic and protective strategies is of urgent interest, and vitamin D is one of the promising agents in this field. In this review, we present data from literature that supports the promising role of vitamin D in treatment and/or prevention of several infections including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review summarizes vitamin D metabolism and its role in inflammation, thrombosis and immune regulation. It also reviews, in short, the role of vitamin D and the impact of its deficiency in several infections namely tuberculosis, influenza, human immunodeficiency virus (HIV), and SARS-CoV-2. Considering the roles of vitamin D on immune modulation, controlling of thrombosis, and attacking several microorganisms, the current review will elaborate on the association between these salient roles of vitamin D and the pathogenicity of various infectious agents including COVID-19. Consequently, the comprehensive finding of the current review shows a possible significant impact of vitamin D supplement as a hope in preventing, treating, and/or improving the progression of certain infections, specifically during the worldwide attempts to fight against the COVID-19 pandemic and minimize the severity of health complications encountered accordingly. In addition, avoiding a status of vitamin D deficiency to obtain its positive effects on the immune system and its protective mechanism during infections will be a general benefit overall.
CONTEXT: Hyperuricemia is prevalent in patients with chronic kidney disease (CKD). Although it is associated with CKD incidence and progression, treating asymptomatic hyperuricemia with uric acid-lowering agents is still debatable. AIM OF WORK: determine the rate of non-classical prescription of allopurinol in CKD patients. SETTINGS AND DESIGN: This was a retrospective study of adult patients prescribed allopurinol with CKD (stages 2-5) in Doctor Soliman Fakeeh Hospital (DSFH) Jeddah, Saudi Arabia, from 1/1/2016 to 1/1/2017. SUBJECTS AND METHODS: Eligible patients were identified from the hospital's pharmacy system and cross-referenced with the electronic health records. Demographic data, laboratory results and indication as recorded by the prescribing physician were extracted. Prescriptions with no indication were categorized based on the uric acid levels. Hyperuricemia was documented as mild (6-10 mg/dL in females and 7-13 mg/dL in males) and severe (>13mg/dL in men and >10mg/dL in women). STATISTICAL ANALYSIS USED: Descriptive statistics (frequencies, percentages). RESULTS: From the 594 identified patients, 464 (78.1%) were males. A third of prescriptions (209/594) had no indication, 43.5% of which (91/209) had no documented uric acid levels, and 16.3% (34/209) had normal levels. Including patients with undocumented indication, 64.2% (381/594) were prescribed allopurinol for hyperuricemia, 86.4% of which (329/381) had mild hyperuricemia, and only 13.6% (52/381) had severe hyperuricemia. Other indications included malignancy-related disorders (6.2%, 37/594), gouty arthritis (5.2%, 31/594), and stones of unknown aetiology (3.4%, 20/594). CONCLUSION: The percentage of allopurinol prescription to patients with CKD without a clear indication in our centre was markedly high. This might increase the risk for side effects with no evidence-based benefits.
Globally, increasing demand for rheumatology services has led to a greater reliance on non-physician healthcare professionals (HCPs), such as rheumatology nurse specialists, to deliver care as part of a multidisciplinary team. Across Africa and the Middle East (AfME), there remains a shortage of rheumatology HCPs, including rheumatology nurses, which presents a major challenge to the delivery of rheumatology services, and subsequently the treatment and management of conditions such as rheumatoid arthritis (RA). To further explore the importance of nurse-led care (NLC) for patients with RA and create a set of proposed strategies for the implementation of NLC in the AfME region, we used a modified Delphi technique. A review of the global literature was conducted using the PubMed search engine, with the most relevant publications selected. The findings were summarized and presented to the author group, which was composed of representatives from different countries and HCP disciplines. The authors also drew on their knowledge of the wider literature to provide context. Overall, results suggest that NLC is associated with improved patient perceptions of RA care, and equivalent or superior clinical and cost outcomes versus physician-led care in RA disease management. Expert commentary provided by the authors gives insights into the challenges of implementing nurse-led RA care. We further report practical proposed strategies for the development and implementation of NLC for patients with RA, specifically in the AfME region. These proposed strategies aim to act as a foundation for the introduction and development of NLC programs across the AfME region.
Arthritis, Rheumatoid/nursing , Nurse Specialists/organization & administration , Practice Patterns, Nurses'/organization & administration , Rheumatology/organization & administration , Africa , Arthritis, Rheumatoid/drug therapy , Delphi Technique , Female , Humans , Male , Middle East , Nurse Specialists/supply & distribution , Patient Satisfaction , Rheumatology/economics
Estimates of the global prevalence of rheumatoid arthritis (RA) range from 0.24 to 1%, but vary considerably around the globe. A variation in RA prevalence is also expected across Africa and the Middle East, due to ethnic, climate, and socioeconomic differences. To assess the prevalence of RA in Africa and the Middle East, we searched Medline (via PubMed) and databases of major rheumatology conferences. Seventeen journal articles and 0 abstracts met the inclusion criteria. Estimated prevalence ranged from 0.06 to 3.4%. Most studies reported values near or below 0.25%. Consistent with data from other regions, RA was more prevalent among urban than rural populations, and among women than men. The women:men prevalence ratio ranged from 1.3:1 to 12.5:1, which suggests notable differences from the global average of 2:1. Relative increases in prevalence were observed in North Africa and the Middle East (13% since 1990) and Western Sub-Saharan Africa (14%), whereas rates in Eastern, Central, and Southern Sub-Saharan Africa show decreases (4-12%). Low disease awareness, delays to visit rheumatologists, and socioeconomic factors appear to hinder early diagnosis and aggressive treatment. Few countries have developed RA-specific treatment guidelines, and many physicians and patients face limited access to even basic treatments. An improved understanding of the epidemiology and management of RA, and the related socioeconomic consequences is necessary, so that targeted attempts can be made to encourage early diagnosis and treatment.
BACKGROUND: Worldwide research anticipates that a current shortage of rheumatologists will exacerbate over the next decade, whereas the need for arthritis specialists will continue to escalate. Saudi Arabia (SA) also encounters a limited geographical distribution of rheumatologists and rheumatology fellowship training centres. OBJECTIVE: Reporting the Saudi rheumatologists' advisory meeting conducted in Makkah, SA in January 2020 with the aim to discuss the "Saudi Vision 2030" for rheumatology training programs. MATERIALS AND METHODS: A meeting of Saudi rheumatology experts and consultants was conducted to address the future directions, challenges, and recommendations of rheumatology training. The 10th Rheumatology Practice Symposium was organised by Alzaidi Chair of Research in Rheumatic Diseases (ZCRD), and conducted in Makkah Commerce Chamber, Makkah, SA on January 28, 2020. More than 30 consultants and rheumatology fellows with five Saudi experts in the field of rheumatology assembled to form 10 recommendations that tackle rheumatology training challenges in SA. RESULTS: The meeting recommendations shed light on the clinical practice of rheumatology training in SA; challenges and opportunities in rheumatology fellowship programs; efforts of the Saudi Commission for Health Specialties (SCFHS) to design and implement a competent postgraduate rheumatology training; and challenges with trainers, trainee, and within training centres. CONCLUSION: To address rheumatology challenges in SA, rheumatology consultants and fellows assembled to form 10 recommendations. The recommendations tackled the challenges of rheumatology fellowship programs and the efforts to implement a competent postgraduate rheumatology training. These recommendations are expected to lead us successfully to fulfil our ambition in the "Saudi Vision of 2030".
PHENOMENON: Peer-assisted learning (PAL) is increasingly used in different fields of education, including medical education, due to its established advantages. However, there are scarce data about the best practice guidelines for PAL program evaluation. The aim of this work was to develop a framework that can describe and develop PAL programs and consequently provide a tool for evaluation and comparison of PAL programs among different institutions. APPROACH: A thorough literature review was made for assessment of different PAL programs development and implementation strategies, and PAL leaders at the University of Umm Al-Qura in Saudi Arabia were interviewed for development and revision of a framework for PAL program development, description and evaluation. FINDINGS: A framework of four sections was developed ie context, theory, implementation processes and outcomes, and emergence. The context includes the learning objectives and the logistics. The theory includes the content nature, program design, number of tutees and tutors, participation, program orientation, program duration and timing, tutor recruitment and preparation and faculty involvement. Implementation process and outcome section includes the feedback collection and the pre- and post-intervention students' assessment. The emergence includes tracking the program evolution. INSIGHTS: Development of a clear well-defined framework for description, implementation and evaluation of a PAL educational program can provide a foundation to unify the terms organizations use to communicate the parameters of PAL programs and overcome the jargon about PAL in the literature. It also can provide comparisons between the programs in an attempt to set best practice guidelines in the future for PAL program developing and implementation.
Secukinumab, "an IL-17 antagonist", is one of the biological agents used to treat active ankylosing spondylitis (AS). Although it has been proven that certain agents are linked with a paradoxical increase in uveitis, there are limited data on whether secukinumab has this effect or not. We report a case of a new-onset anterior uveitis after 6 months of starting secukinumab in a 47-year-old male, HLA-B27 positive AS patient. He had a long-standing history with the disease over 25 years. He was treated in the past with methotrexate then adalimumab and later on with etanercept. He had no history of uveitis during all of this time. The uveitis was mild and treated conventionally with local measures while secukinumab was maintained. After a close follow-up, the uveitis had completely resolved. Is this part of the original disease or a possible side effect from secukinumab?
BACKGROUND: National Registries are essential to direct current practice. Rheumatoid arthritis (RA) registries in the middle east and North Africa remain scarcely represented. OBJECTIVE: To describe a population of Saudi RA patients and to compare the findings to internationally reported data. METHODS: This is an observational study that was conducted at Doctor Soliman Fakeeh Hospital (DSFH) in Saudi Arabia. The study ran from 2014 to 2018 using a pool of 433 patients. Inclusion criteria included adults older than 18 years of age who fulfilled the 2010 American College of Rheumatology criteria for the diagnosis of RA and who were also regular visitors in our rheumatology clinics. Data were collected directly from patients and entered in a specially designed program. RESULTS: At initial presentation, 45.5% had demonstrated active disease (moderate or high disease activity) based on DAS-28-CRP scores, while 54.5% were in low disease activity or remission. The remission rates after 1 year had increased to 79.6% (345 patients), while 9.7% (42 patients) and 10.6% (46 patients) had low disease activity and moderate disease activity, respectively. It was also found that the female gender, higher Health Assessment Questionnaire-Disability Index (HAQ-DI) and longer lag1/lag2 periods were associated with higher disease activity in our population. CONCLUSION: We detected higher remission rates at 1 year of follow-up. This could be attributed to many factors, including good referral systems with easier access to biologics. We aim to expand this registry to the national level.
Juvenile spondyloarthritis (SpA) affects patients below the age of 16 and mainly presents with peripheral involvement. Many atypical clinical presentations were reported in the adult SpA, but not in the juvenile group. We report a case of non-radiographic axial SpA in a 14-year-old girl presented atypically with muscle weakness and hyperthyroidism. She had sacroiliitis evident by magnetic resonance imaging (MRI) with negative HLA-B27. Muscle biopsy showed fasciitis. She responded well to adalimumab and thyroid functions returned to normal values.
BACKGROUND: Early diagnosis and therapeutic management of inflammatory arthritis (IA) is crucial for minimizing disease progression and improving outcomes. We recently developed the New Early Arthritis Referral Criteria to help improve the detection of suspected early IA via musculoskeletal (MSK) examination. The present study aimed to evaluate the agreement between rheumatologists and primary care physicians (PCPs) trained by rheumatologists in detecting IA when applying the standardized MSK examination techniques used to develop this criteria in a real-world setting in Jeddah, Saudi Arabia. METHODS: This quasi-experimental study was conducted in 4 primary health centers and involved 30 PCPs and 3 rheumatologists. All PCPs were trained by rheumatologists to apply the standardized MSK examination techniques used to develop the New Early Arthritis Referral Criteria. Patients were eligible if they were >18 years of age and presented with small-joint pain that persisted for >6 weeks. Patients were excluded if they had prior diagnosis of osteoarthritis, hand fractures, or rheumatic disease associated with IA. All patients were examined separately by a PCP and a rheumatologist, with the findings compared via kappa statistics and the rheumatologist's findings considered the "gold standard". RESULTS: Data from 202 of the 203 enrolled patients were analyzed. There was fair-to-moderate agreement between PCPs and rheumatologists when assessing swelling of the small joints and wrist of the right side (range of kappa: 0.14-0.41) and low-to-moderate agreement in similar examinations of the left side (range of kappa: 0.04-0.42). Assessments of joint tenderness showed fair-to-moderate agreement for both the right side (range of kappa: 0.22-0.47) and left side (range of kappa: 0.24-0.45). P-values were significant for virtually all comparisons. CONCLUSION: MSK examinations by PCPs showed a promising extent of agreement in detecting IA with those by rheumatologists following training. Refinement of the standardized training process could further improve accuracy and help PCPs to confidently identify cases of early IA, thus allowing earlier intervention than is typical in this setting.
PURPOSE: Ability to work is an important endpoint in rheumatoid arthritis (RA). It is not clear what outcome measures should be used to guide treatment in order to maximize workability. This study addressed the impact of RA on workability in a Saudi population and examined the correlation between objective measures of disease activity and reduced workability. This will allow better understanding of treatment targets that will translate into improved workability. PATIENTS AND METHODS: Data were collected through a digital patient record keeper: The Rheumatoid Arthritis Saudi Database. Male and female patients, ≥18 years of age, that met the American College for Rheumatology criteria for diagnosis of RA, were recruited, regardless of treatment. Demographic and disease-specific data were collected. Disease Activity Score-28 (DAS-28) was used to define patients as low (DAS-28 ≤3.2) vs high (DAS-28 >3.2) disease activity. Health assessment questionnaire (HAQ) score, visual analog scale (VAS) score, and musculoskeletal ultrasound 7 joint score were documented also. The work productivity and activity impairment (WPAI) score was used to measure absenteeism, presenteeism, overall work impairment, and activity impairment. DAS-28 score was correlated with WPAI score and linear regression used to identify the demographic and measures of treatment response that predict improvement in WPAI score. RESULTS: Higher absenteeism and more activity impairment were seen for patients with persistent DAS-28 >3.2 (non-achievers). HAQ and VAS scores correlated with presenteeism, overall work impairment, and activity impairment. CONCLUSION: Disease activity, as defined by DAS-28 score, correlates with absenteeism and work impairment in a Saudi population. However, on linear regression analysis, HAQ and VAS scores were the only measures predictive of work impairment. These scores should be used to monitor response to treatment regimens that aim to maximize work potential for Saudi individuals.
BACKGROUND: Inhibitors of tumor necrosis factor alpha (TNF-α) are current mainstay of therapies for rheumatoid arthritis (RA). The decision when to withdraw TNF-α inhibitors after achieving remission and the incidence of relapse rates with elective discontinuation are both important questions that demand intense survey in these patients. In this meta-analysis we aimed to estimate the magnitude of relapse rate after elective TNF-α inhibitor discontinuation in RA patients with remission. METHODS: Systematic searches of PubMed/MEDLINE, Cochrane Library databases, grey literature (unpublished and ongoing trials) from the WHO International Clinical Trials Registry Platform and the US National Institutes of Health were performed for studies reporting the outcomes of elective discontinuation of TNF-α inhibitor in RA patients after remission. Random-effects models for meta-analyses were conducted on extracted data. RESULTS: Out of 390 references screened, 16 RCTs were included. Meta-analysis of 1264 patient data revealed a relapse rate of 0.47 (95% CI 0.41-0.54). Sensitivity analysis showed that none of the studies had higher influence on the results. CONCLUSIONS: Almost half of all the RA patients in remission relapse after elective TNF-α inhibitor discontinuation. This information might be useful when considering this management option with individual patients.
OBJECTIVE: Conventional treatment of systemic lupus erythematosus (SLE) and lupus nephritis (LN) is associated with damage accrual, hence increased morbidity rate. Off-label use of rituximab (RTX) has shown significant promise in this patient group; however, data are still controversial. We aimed to analyze the outcomes of RTX therapy in refractory lupus using a meta-analysis approach. METHODS: Electronic search of the medical literature was conducted using a combination of relevant keywords to retrieve studies on the safety and efficacy of RTX in SLE and LN patients. Results were screened against our inclusion and exclusion criteria and two reviewers independently extracted the data for analysis. Comprehensive meta-analysis software was used to pool the data from individual studies and provide summary effect estimates. RESULTS: Thirty-one studies that enrolled 1112 patients were finally eligible for the meta-analysis. The overall global, complete, and partial response rates to RTX therapy were 72%, 46%, and 32%, respectively. RTX significantly decreased Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and British Isles Lupus Activity Group (BILAG) scores (p<0.001). Prednisone dose was significantly reduced after RTX treatment in both SLE and LN groups (p<0.001), and proteinuria was lowered in SLE (p<0.001) than in LN patients (p=0.07). Infection and infusion-related reactions were the most common side effects. CONCLUSION: RTX therapy in refractory SLE and LN patients proved clinical efficacy and favorable safety outcomes. Larger well-designed randomized clinical trials are warranted.
