Rituximab in the treatment of severe lupus myelopathy

Lupus myelopathy (LM) is a rare but critical condition, and the prognosis is grim for patients with severe initial motor deficits despite aggressive conventional immunosuppressive therapy. In this report, six recent-onset severe LM patients with lower extremity muscle strength less than or equal to grade 3 were treated with rituximab combined with pulse methylprednisolone. Four patients showed complete myelopathy response at 12 months. The safety profile of rituximab was tolerable, with urinary tract infection as the most frequent adverse event. Preliminary data indicated that rituximab could be beneficial in preventing permanent neurological damage in severe LM.