Evidence map›Paper›PMID 41482402›Full record

ArticleIn vivo (Athens, Greece)

Rhupus Syndrome With Multiple Drug Intolerances Managed by Reduced-dose Rituximab and Adjunctive Molecular Hydrogen Therapy: A Case Report.

Han-Luen Tsai, Jeng-Wei Lu, Yi-Jung Ho, Shan-Wen Lui, Ting-Yu Hsieh, Kuang-Yih Wang, Feng-Cheng Liu

Abstract readCase Reports
In one paragraph

Article in In vivo (Athens, Greece). The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Han-Luen TsaiDepartment of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan, R.O.C.
Jeng-Wei LuDepartment of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung, Taiwan, R.O.C.
Yi-Jung HoSchool of Pharmacy, National Defense Medical University, Taipei, Taiwan, R.O.C.
Shan-Wen LuiDepartment of Internal Medicine, Linkou Chang-Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C.
Ting-Yu HsiehDepartment of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.
Kuang-Yih WangRheumatology/Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan, R.O.C.
Feng-Cheng LiuRheumatology/Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan, R.O.C.; lfc10399@yahoo.com.tw.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND/

aimRhupus syndrome, an overlap of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), is a rare condition characterized by heterogeneous clinical manifestations and difficult management. Conventional therapies, including glucocorticoids, disease-modifying anti-rheumatic drugs (DMARDs), immunosuppressants, and biologics, are often limited by drug intolerance and steroid-related complications. Molecular hydrogen (H CASE REPORT: We report a 47-year-old male with a 27-year history of rheumatoid arthritis, who subsequently developed systemic lupus erythematosus, fulfilling criteria for Rhupus syndrome. His disease course was complicated by multiple drug intolerances, including adverse reactions to methotrexate, sulfasalazine, hydroxychloroquine, azathioprine, leflunomide, and rituximab at standard dosing. Despite reduced-dose rituximab and mycophenolic acid, disease activity persisted and lupus nephritis was confirmed. In October 2023, oral molecular hydrogen capsule therapy was initiated as adjuvant treatment, resulting in significant clinical improvement, which was paralleled by characteristic changes in T- and B-cell subsets, normalization of anti-dsDNA antibody, erythrocyte sedimentation rate (ESR), and complement levels, and successful discontinuation of prednisone. Hydrogen therapy was well tolerated without major adverse effects. The patient developed avascular necrosis from prior corticosteroid use but recovered well after hip arthroplasty in January 2025. Disease control was sustained with mycophenolic acid and continued hydrogen therapy.

conclusionThis case suggests molecular hydrogen therapy as a potential adjuvant for refractory Rhupus with multiple drug intolerances, showing immune modulation, reduced inflammation, steroid withdrawal, and sustained control with low-dose rituximab. Further studies are needed to confirm its efficacy and standardize its use.

Indexed as

Arthritis, RheumatoidHydrogenLupus Erythematosus, SystemicRituximabAntirheumatic AgentsHumansMaleMiddle AgedTreatment OutcomeAntirheumatic AgentsHydrogenRituximabCase reporthydrogen therapyrheumatoid arthritisRhupus syndromesystemic lupus erythematosus

Identifiers

PMID41482402
PMCPMC12764188

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.