Sacroiliitis in Systemic Lupus Erythematosus–Systemic Sclerosis Overlap Syndrome: A Therapeutic Challenge

CASE REPORT
Mousa A. Albalwi

 

For citation: Albalwi MA. Sacroiliitis in Systemic Lupus Erythematosus–Systemic Sclerosis Overlap Syndrome: A Therapeutic Challenge. International Journal of Biomedicine. 2026;16(3):388-394. doi:10.21103/Article16(3)_CR1

Originally published September 5, 2026

Abstract: 

Axial skeletal involvement is rare in systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) and is not typically recognized in their overlap. We describe a 35-year-old woman with a 4-year history of SLE–SSc overlap who developed inflammatory low-back pain and progressive dyspnea. High-resolution computed tomography showed new usual-interstitial-pneumonia-pattern interstitial lung disease (ILD); sacroiliac magnetic resonance imaging confirmed bilateral active sacroiliitis; HLA-B27 was negative. After methotrexate withdrawal, mycophenolate, and nintedanib, rituximab was given for progressive ILD and produced both pulmonary stabilization and resolution of axial symptoms, allowing nonsteroidal anti-inflammatory drug discontinuation. Rituximab may offer dual benefit in overlap-associated sacroiliitis with ILD.

Keywords: 
interstitial lung disease • rituximab • MRI • connective tissue diseases
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Received May 21, 2026.
Accepted July 11, 2026.
© 2026 The Author(s). International Journal of Biomedicine is published by IMRDC. This is an open access article under the CC BY-NC-ND 4.0 license.