Rituximab treatment for rhupus syndrome: a systematic literature review
Vol. 32 No. 2 (2024), Review articles
Vol. 32 No. 2 (2024)

Rituximab treatment for rhupus syndrome: a systematic literature review

Review articles
https://doi.org/10.35465/32.2.2024.pp34-45
Published December 22, 2024
Saoussen Miladi
Mongi Slim hospital, department of Rheumatology
HIBA BEN AYED
Mongi Slim hospital, department of Rheumatology
Yasmine Makhlouf
Mongi Slim hospital, department of Rheumatology
Hiba Boussaa
Mongi Slim hospital, department of Rheumatology
Leith Zakraoui
Mongi Slim hospital, department of Rheumatology
Kawther Ben Abdelghani
Mongi Slim hospital, department of Rheumatology
Alia Fazaa
Mongi Slim hospital, department of Rheumatology
Ahmed Laatar
Mongi Slim hospital, department of Rheumatology
PDF

Keywords

systemic lupus erythematosus; rheumatoid arthritis; rituximab; biologics.

How to Cite

Miladi, S., BEN AYED, H., Makhlouf, Y., Boussaa, H., Zakraoui, L., Ben Abdelghani, K., Fazaa, A., & Laatar, A. (2024). Rituximab treatment for rhupus syndrome: a systematic literature review. Rheumatology (Bulgaria), 32(2), 34-45. https://doi.org/10.35465/32.2.2024.pp34-45
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver

Download Citation

Endnote/Zotero/Mendeley (RIS) BibTeX

Abstract

Introduction: Rhupus is a poorly described and underdiagnosed disease in which features of both rheumatoid arthritis (RA) and systemic lupus erythematous (SLE) appear in the same patient. Herein, we present a systematic literature review to analyze the clinical, laboratory and radiological data of all reported rhupus patients treated with rituximab (RTX).

Methods: This systematic review followed the preferred reporting items for systematic reviews guidelines. Eligible articles were searched in Medline, Embase, and Cochrane Library. We analyzed cohort studies, case series and case reports.

Results: Four papers were finally selected for analysis. The studies were published between 2012 and 2022. Overall, 29 patients were included. All rhupus patients were previously treated with conventional Disease-Modifying Antirheumatic Drugs (DMARDs) and RTX was the first biologic DMARD prescribed in 22 patients. A significant reduction in mean the 28 Disease-activity-score (DAS28) from baseline to the end of follow-up was observed in all the studies. Mean DAS28 decreased from 5.65 to 3.65. The clinical activity of SLE was evaluated in 2 studies using The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Overall, mean SLEDAI decreased from 6.05 at baseline to 2.66 at the end of follow-up Based on the ultrasonographic (US) disease activity assessment performed one study, US count scores progressively reduced, indicating that a US response was sustained after RTX treatment. Overall, only two severe adverse events were noted.

Conclusion: In the light of this literature systematic review, RTX seems to be effective and safe in rhupus syndrome.

https://doi.org/10.35465/32.2.2024.pp34-45
PDF

References

  1. Amezcua-Guerra LM. Overlap between systemic lupus erythematosus and rheumatoid arthritis: is it real or just an illusion? J Rheumatol. 2009 Jan;36(1):4–6.
  2. Schur: Systemic lupus erythematosus in Cecil-Loeb... - Google Scholar [Internet]. [cited 2023 Sep 29]. Available from: https://scholar.google.com/scholar_lookup?title=Systemic+lupus+erythematosus+in+Cecil-Loeb+Texbook+of+Medicine&author=PH+Schur&publication_year=1971&
  3. Solis Cartas U, Martínez Larrarte JP, Prada Hernández DM, Gómez Morejón JA, Valdés González JL, Molinero Rodríguez C. Rhupus syndrome. A rare combination. Rev Colomb Reumatol Engl Ed. 2017 Oct 1;24(4):237–41.
  4. Iaccarino L, Gatto M, Bettio S, Caso F, Rampudda M, Zen M, et al. Overlap connective tissue disease syndromes. Autoimmun Rev. 2013 Jan;12(3):363–73.
  5. Li J, Wu H, Huang X, Xu D, Zheng W, Zhao Y, et al. Clinical analysis of 56 patients with rhupus syndrome: manifestations and comparisons with systemic lupus erythematosus: a retrospective case-control study. Medicine (Baltimore). 2014 Aug;93(10):e49.
  6. Antonini L, Le Mauff B, Marcelli C, Aouba A, de Boysson H. Rhupus: a systematic literature review. Autoimmun Rev. 2020 Sep;19(9):102612.
  7. Upadhyaya S, Agarwal M, Upadhyaya A, Pathania M, Dhar M. Rhupus Syndrome: A Diagnostic Dilemma. Cureus. 2022 Sep;14(9):e29018.
  8. Tani C, D’Aniello D, Delle Sedie A, Carli L, Cagnoni M, Possemato N, et al. Rhupus syndrome: assessment of its prevalence and its clinical and instrumental characteristics in a prospective cohort of 103 SLE patients. Autoimmun Rev. 2013 Feb;12(4):537–41.
  9. Araújo F, Silva I, Sepriano A, Nero P, Branco JC. Off-label use of rituximab in systemic rheumatic diseases: case series and review. Acta Reumatol Port. 2013;38(4):290–4.
  10. Rottenberg P, Brevet P, Leclercq M, Jouen F, Marie I, Lévesque H, et al. Potential Benefit of Rituximab in Rhupus Patients From a Single-Center: A Series of 16 Cases. J Clin Rheumatol Pract Rep Rheum Musculoskelet Dis. 2022 Dec 1;28(8):e699–702.
  11. Piga M, Gabba A, Cauli A, Garau P, Vacca A, Mathieu A. Rituximab treatment for ‘rhupus syndrome’: clinical and power-Doppler ultrasonographic monitoring of response. A longitudinal pilot study. Lupus. 2013 May;22(6):624–8.
  12. Andrade-Ortega L, Irazoque-Palazuelos F, Muñóz-López S, Rosales-Don Pablo VM. Efficacy and tolerability of rituximab in patients with rhupus. Reumatol Clin. 2013;9(4):201–5.
  13. McCarthy EM, Sutton E, Nesbit S, White J, Parker B, Jayne D, et al. Short-term efficacy and safety of rituximab therapy in refractory systemic lupus erythematosus: results from the British Isles Lupus Assessment Group Biologics Register. Rheumatol Oxf Engl. 2018 Mar 1;57(3):470–9.
  14. Merrill JT, Neuwelt CM, Wallace DJ, Shanahan JC, Latinis KM, Oates JC, et al. Efficacy and safety of rituximab in moderately-to-severely active systemic lupus erythematosus: the randomized, double-blind, phase II/III systemic lupus erythematosus evaluation of rituximab trial. Arthritis Rheum. 2010 Jan;62(1):222–33.
  15. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372:n71.
  16. Munn Z, Barker TH, Moola S, Tufanaru C, Stern C, McArthur A, et al. Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evid Synth. 2020 Oct;18(10):2127–33.
  17. Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D. The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development. Glob Adv Health Med. 2013 Sep;2(5):38–43.
  18. Levin RE, Weinstein A, Peterson M, Testa MA, Rothfield NF. A comparison of the sensitivity of the 1971 and 1982 american rheumatism association criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1984;27(5):530–8.
  19. Inês L, Silva C, Galindo M, López-Longo FJ, Terroso G, Romão VC, et al. Classification of Systemic Lupus Erythematosus: Systemic Lupus International Collaborating Clinics Versus American College of Rheumatology Criteria. A Comparative Study of 2,055 Patients From a Real-Life, International Systemic Lupus Erythematosus Cohort. Arthritis Care Res. 2015 Aug;67(8):1180–5.
  20. Gheorghiu AM, Vrancianu C, Conea I, Boca A, Bolboceanu M, Draganescu C, et al. Performance of the New 2019 European Alliance of Associations for Rheumatology/American College of Rheumatology Systemic Lupus Erythematosus Classification Criteria in a Large Unicentric Cohort. Diagn Basel Switz. 2022 Nov 14;12(11):2778.
  21. Kay J, Upchurch KS. ACR/EULAR 2010 rheumatoid arthritis classification criteria. Rheumatol Oxf Engl. 2012 Dec;51 Suppl 6:vi5-9.
  22. Simón JA, Granados J, Cabiedes J, Morales JR, Varela JA. Clinical and immunogenetic characterization of Mexican patients with ‘rhupus’. Lupus. 2002;11(5):287–92.
  23. Collado P, Gamir ML, López-Robledillo JC, Merino R, Modesto C, Monteagudo I. Detection of synovitis by ultrasonography in clinically inactive juvenile idiopathic arthritis on and off medication. Clin Exp Rheumatol. 2014 Aug;32(4):597–603.
  24. Madsen OR. Is DAS28-CRP with three and four variables interchangeable in individual patients selected for biological treatment in daily clinical practice? Clin Rheumatol. 2011 Dec;30(12):1577–82.
  25. Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D’Agostino MA, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 2005 Dec;32(12):2485–7.
  26. Klarenbeek NB, Güler-Yüksel M, Heijde DMFM van der, Kerstens PJSM, Mallée C, Westedt ML, et al. A comparison between the simplified erosion and narrowing score and the Sharp–van der Heijde score: post hoc analysis from the BeSt study. Ann Rheum Dis. 2011 Apr 1;70(4):714–6.
  27. Le Loët X. [Evaluation of the clinical activity of systemic lupus erythematosus]. Ann Med Interne (Paris). 1990;141(3):261–4.
  28. Uribe AG, Vilá LM, McGwin G, Sanchez ML, Reveille JD, Alarcón GS. The Systemic Lupus Activity Measure-revised, the Mexican Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and a modified SLEDAI-2K are adequate instruments to measure disease activity in systemic lupus erythematosus. J Rheumatol. 2004 Oct;31(10):1934–40.
  29. Thiele K, Huscher D, Bischoff S, Späthling-Mestekemper S, Backhaus M, Aringer M, et al. Performance of the 2011 ACR/EULAR preliminary remission criteria compared with DAS28 remission in unselected patients with rheumatoid arthritis. Ann Rheum Dis. 2013 Jul;72(7):1194–9.
  30. Lozada-Navarro AC, Castillo-Martínez D, Moreno-Ramírez M, Acosta-Peña G, Páez A, Massó F, et al. An imbalance in the T-helper phenotypes displayed by senescent CD4+CD28null T cells is associated with erosive arthritis (rhupus syndrome) in systemic lupus erythematosus. Lupus. 2018 Nov;27(13):2155–60.
  31. Orozco G, Eyre S, Hinks A, Bowes J, Morgan AW, Wilson AG, et al. Study of the common genetic background for rheumatoid arthritis and systemic lupus erythematosus. Ann Rheum Dis. 2011 Mar;70(3):463–8.
  32. Ceccarelli F, Natalucci F, Olivieri G, Perricone C, Pirone C, Spinelli FR, et al. Erosive arthritis in systemic lupus erythematosus: not only Rhupus. Lupus. 2021 Nov;30(13):2029–41.
  33. Yang BB, Xiao H, Li XJ, Zheng M. Safety and efficacy of etanercept-methotrexate combination therapy in patients with rhupus: an observational study of non-glucocorticoid treatment for rheumatic diseases. Discov Med. 2018 Jan;25(135):14–20.
  34. Ikeda K, Sanayama Y, Makita S, Hosokawa J, Yamagata M, Nakagomi D, et al. Efficacy of abatacept for arthritis in patients with an overlap syndrome between rheumatoid arthritis and systemic lupus erythematosus. Clin Dev Immunol. 2013;2013:697525.
  35. Patient with Systemic Lupus Erythematosus Combined with Erosive Arthritis was Treated Successfully with Tocilizumab: A Case Report [Internet]. [cited 2023 Sep 25]. Available from: https://www.jrd.or.kr/journal/view.html?pn=vol&uid=1343&vmd=Full
  36. Kondo H, Watanabe R, Okazaki S, Kuriyama K, Harigae H, Fujii H. Coexistence of rheumatoid arthritis and systemic lupus erythematosus is still rare in the biologic era: Report of seven cases and literature review. Mod Rheumatol. 2020 Nov;30(6):1082–3.
  37. Castillo Dayer PV, Lozano Rivas N, Martínez Ferrín JJ, Victoria Martínez AM, Sánchez-Pedreño Guillen P, Marras Fernández-Cid C. Belimumab treatment in rhupus: A case report with severe skin involvement. Dermatol Ther. 2019 Sep;32(5):e13056.
  38. Buch MH, Smolen JS, Betteridge N, Breedveld FC, Burmester G, Dörner T, et al. Updated consensus statement on the use of rituximab in patients with rheumatoid arthritis. Ann Rheum Dis. 2011 Jun;70(6):909–20.
  39. Keystone E, Emery P, Peterfy CG, Tak PP, Cohen S, Genovese MC, et al. Rituximab inhibits structural joint damage in patients with rheumatoid arthritis with an inadequate response to tumour necrosis factor inhibitor therapies. Ann Rheum Dis. 2009 Feb;68(2):216–21.
  40. Zvaifler NJ. The immunopathology of joint inflammation in rheumatoid arthritis. Adv Immunol. 1973;16(0):265–336.
  41. Safety and efficacy of rituximab in systemic lupus erythematosus: results from 136 patients from the French AutoImmunity and Rituximab registry - PubMed [Internet]. [cited 2023 Sep 26]. Available from: https://pubmed.ncbi.nlm.nih.gov/20506527/
  42. Garcia-Carrasco M, Mendoza-Pinto C, Sandoval-Cruz M, Soto-Vega E, Beltran-Castillo A, Jimenez-Hernandez M, et al. Anti-CD20 therapy in patients with refractory systemic lupus erythematosus: a longitudinal analysis of 52 Hispanic patients. Lupus. 2010 Feb;19(2):213–9.
  43. Gladman DD, Ibañez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol. 2002 Feb;29(2):288–91.
  44. Levine TD. Rituximab in the treatment of dermatomyositis: an open-label pilot study. Arthritis Rheum. 2005 Feb;52(2):601–7.
  45. Meijer JM, Meiners PM, Vissink A, Spijkervet FKL, Abdulahad W, Kamminga N, et al. Effectiveness of rituximab treatment in primary Sjögren’s syndrome: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2010 Apr;62(4):960–8.
  46. Daoussis D, Melissaropoulos K, Sakellaropoulos G, Antonopoulos I, Markatseli TE, Simopoulou T, et al. A multicenter, open-label, comparative study of B-cell depletion therapy with Rituximab for systemic sclerosis-associated interstitial lung disease. Semin Arthritis Rheum. 2017 Apr;46(5):625–31.
  47. Damián-Abrego GN, Cabiedes J, Cabral AR. Anti-citrullinated peptide antibodies in lupus patients with or without deforming arthropathy. Lupus. 2008 Apr;17(4):300–4.
  48. Chan MT, Owen P, Dunphy J, Cox B, Carmichael C, Korendowych E, et al. Associations of erosive arthritis with anti-cyclic citrullinated peptide antibodies and MHC Class II alleles in systemic lupus erythematosus. J Rheumatol. 2008 Jan;35(1):77–83.
  49. Liu T, Li G, Mu R, Ye H, Li W, Li Z. Clinical and laboratory profiles of rhupus syndrome in a Chinese population: a single-centre study of 51 patients. Lupus. 2014 Aug;23(9):958–63.
  50. Zhao Y, Li J, Li X xia, Li C, Li L, Li Z guo. What can we learn from the presence of anti-cyclic citrullinated peptide antibodies in systemic lupus erythematosus? Joint Bone Spine. 2009 Oct;76(5):501–7.
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Downloads

Download data is not yet available.

Most read articles by the same author(s)