Systemic lupus erythematosus (SLE) is a common autoimmune disease in children. Current standard therapies
carry high adverse effects. Refractory SLE to conventional therapies is not uncommon. Rituximab, anti-CD20 monoclonal
antibody, has been used as an adjunctive therapy in children with refractory SLE with limited reports. This study described
pediatric SLE patients in a single center, Thailand. To determine the clinical manifestations, treatments, and outcome of SLE
patients, the authors retrospectively studied 19 patients (age <15 years) diagnosed with SLE at Thammasat University
hospital, from January 01, 2002 through March 31, 2010. The mean age was 12.9 + 1.6 years; mean follow-up 3.3 + 2.6
years. Seventeen (89.5%) patients were female. Clinical manifestations were hematological (89.5%), dermatologic (73.7%),
and renal involvement (68.4%). SLE was diagnosed 1 year after systemic onset juvenile rheumatoid arthiris in one patient.
Lupus nephritis (LN) class II was observed in 30.8%, class III (15.4%), and class IV (53.8%) of patients with LN. Overall,
mean SLEDAI score at presentation was 14.9 + 2.2 and significantly decreased to 6.8 + 1.6 (p < 0.0001) at 1 month after
treatment. Complete remission at 1 year demonstrated in 11 (68.7%) patients. Infection was the most common complication
followed by ophthalmological complications. All patients survived during follow-up period. Rituximab induced remission of
SLE after refractory diffuse alveolar hemorrhage in one patient, and rapidly progressive glomerulonephirits leading to end
stage renal failure in one patient. Clinical outcome of pediatric SLE was favorable in the present study. Complications from
corticosteroid and anti-inflammatory therapy were high. Rituximab may be a good adjunctive therapy for refractory SLE in
children. Large controlled trials to establish safety profile and optimal regimen of rituximab in childhood SLE are required

Keywords: Systemic lupus erythrematosus, Lupus nephritis, Optic neuritis, Diffuse alveolar hemorrhage, Asian, Children,
Rituximab, IV pulse cyclophosphamide, Systemic onset juvenile Rheumatoid arthritis, Hydroxychlorquine, Chloroquine
maculopathy