Efficacy of rituximab in a patient with lupus nephritis despite low levels of CD19.

摘要

Sir, A 35-year-old woman was diagnosed with SLE in 2002, with specific skin lesions and positive ANA (1/2500). She was treated with HCQ 400mg/day.In 2005, the treatment was changed for MTX and oral corticosteroid due to polyarthritis. Circulating B-cell level in the peripheral blood was normal at that time (CD19~+ = 25% by flow cytometry detection).In April 2006, renal function started to deteriorate with a proteinuria of 5g/day. A renal biopsy was performed and histology showed diffuse proliferative lupus GN. Arterial blood pressure, creatinaemia and renal ultrason-ography were all normal. During this flare, she also had skin rash, polyarthritis and pericarditis. An initial induction period of intensive immunosuppressive therapy was started with i.v. cyclophosphamide (CYC) 0.7 g/m2 every 28 days and high-dose i.v. methylpredni-solone 1 g/day for 3 days, followed by oral prednisone (oral PDN) of 1 mg/kg.