Wanita dengan Sindrom Rupus : Lupus Eritematosus Sistemik dan Artritis Reumatoid
Abstract
Background : The coexistence of two or more connective tissue diseases in the same patient is a rare phenomenon, particularly the coexistence of Sytemic Lupus Erythematosus (SLE) and Rheumatoid Arthrtitis (RA) (0,01 to 2%). Rhupus syndrome is a symmetric deforming polyarthritis of the small and large joints which is erosive on radiography and accompanied by clinical signs and symptoms of SLE and by the presence of specific autoantibodies with high specificity.
Case : A young female, 29 years old with symmetric polyarthritis of both upper and lower limb joints for last six months and was developed in two weeks. There was a history of hair loss for least 1 year. She also gave history of recurrent painful oral ulcers for last 6 months. Examination revealed alopecia, pallor, malar rash, and symmetric polyarthritis. The laboratory results were anemia, thrombocytopenia, positive anti-cyclic citrullinated peptide antibodies, positive rheumatoid factor, increased erythrocyte sedimentation rate, and the immunologic disorder characterized by positive anti-Sm. Plain radiographs of both hands showed erosive polyarthritis. The treatment with methyl prednisolone, methotrexate, calcium, and folic acid. During treatment, she achieved clinical remission.
Discussion : Symmetric polyarthritis at the young age are affected in 90% of the patients with SLE and RA. The beginning of which could not be defined, was coexistent with this overlap syndrome. Diagnosis of RA based on American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) and diagnosis of SLE based on ACR 1997 criteria. The therapy include low to moderate doses systemic corticosteroid and combination with 1-3 Disease-modifying anti-rheumatic drugs (DMARDs).
References
Hochberg Mc. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997; 40: 1725
Cervera R, Khamashta MA, Font J, et al. Morbidity and mortality in systemic lupus erythematosus during a 10 year period, a comparison of early and late manifestation in a cohort of 1000 Patients. Medicine.2003;82: 299-308
Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid Arthritis Classification Criteria An American College of Rheumatology/European League Againts rheumatism Collaborative Initiative. Arthritis Rheum. 2010;62:2569-2581
AlFadhli S, Nizam R. Rupus: A crosswalk between lupus and rheumatoid arthritis. OA Arthritis.2014:10;2(1):3
Messuti L, Zoli A, Gremese E. Joint Involvement in SLE: the Controversy of Rhupus. International Trends in Immunity.2014(2)
Popescu C, Zofota S, Bojinca V, et al. The Significance of Rheumatoid Factor and anti -Cyclic Citrullinated Peptide Antibodies in Systemic Lupus Erythematosus. Rom J Intern Med. 2013:51; 179-187
Icen M, Nicola PJ, Maradit-Kremers H, et al. Systemic lupus erythematosus features in rheumatoid arthritis and their effect on overall mortality. J Rheumatol. 2009; 36:50-57
Satoh M, Ajmani AK, Akizuki M. What is the definition for coexistent rheumatoid arthritis and systemic lupus erythematosus?.Lupus.1994; 3: 137-138
Simon JA, granados J, Cabiedes J, et al. Clinical and immunogenetic characterization of mexican patients with rupus. Lupus. 2002;11(5):287-92.
Li J, Wu H, Huang X, et al. Clinical Analysis of 56 Patients With Rupus Syndrome:Manifestations and Comparisons With Systemic Lupus Erythematosus. Medicine. 2014; 93(10):e49
Kumar Y, Bhatia A, Minz RW. Anti nuclear antibodies and their detection methods in diagnosis of connective tissue diseases: a journey revisited. Diagnostic Pathology.2009;4:1
Cohen MG, Webb J. Concurrence of rheumatoid arthritis and systemic lupus erythematosus: report of 11 cases. Ann Rheum Dis.1987;46:853-858.
Sharma B. RUPUS: REPORT OF 3 CASES. J Indian Rheumatol Assoc. 2003;11:51-54
Amezcua-Guerra LM, Springall R, Marquez-Velasco R, et al. Presence of antibodies against cyclic citrullinated peptides in patients with 'rupus': a cross-sectional study. Arthritis Research & Therapy.2006;8:144
Tani C, D’Aniello D, Delle Sedie A, et al. Rupus syndrome: assessment of its prevalence and its clinical and instrumental characteristics in a prospective cohort of 103 SLE patients. Autoimmun Rev. 2013;12:537-541
Liu T, Li G, Mu R, Ye H, Li W, Li Z. Clinical and laboratory profiles of rupus syndrome in a Chinese population: a single-centre study of 51 patients. Lupus. 2014 Mar 7. [Epub ahead of print] .
Chan MT, Owen P, Dunphy J, et al. Associations of erosive arthritis with anti -cyclic citrullinated peptide antibodies and MHC Class II alleles in systemic lupus erythematosus. J Rheumatol. 2008; 35(1):77-83
Hoffman IE, Peene I, Cebecauer L, et al.Presence of rheumatoid factor and antibodies to citrullinated peptides in systemic lupus erythematosus. Ann Rheum Dis. 2005;64:330-332
Mediwake R, Isenberg DA, Schellekens GA, et al. Use of anti -citrullinated peptide and anti -RA33 antibodies in distinguishing erosive arthritis in patients with systemic lupus erythematosus and rheumatoid arthritis. Annals Rheum Dis.2001;60:67-68
Kakumanu P, Sobel ES, Narain S, et al. Citrulline Dependence of Anti -Cyclic Citrullinated Peptide Antibodies in Systemic Lupus Erythematosus as a Marker of Deforming/Erosive Arthritis. J Rheum.2009;36(12): 2682-2690
Orozco G, Eyre S, Hinks A, et al. Study of the common genetic background for rheumatoid arthritis and systemic lupus erythematosus. Ann Rheum Dis.2011;70:463-468
Orozco G, Barton A. Update on the genetic risk factors for rheumatoid arthritis. Expert Rev Clin Immunol. 2010; 6: 61-75
Suarez-Gestal M, Calaza M, Dieguez-Gonzalez R, et al. Rheumatoid Arthritis Does Not Share Most of the Newly Identified Systemic Lupus Erythematosus Genetic Factors. Arthritis Rheum. 2009; 60(9): 2558-2564
Once an article was published in the journal, the author(s) are: granted to the journal right licensed under Creative Commons License Attribution that allows others to share the work with an acknowledgement of the work's authorship. permitted to publish their work online in third parties as it can lead wider dissemination of the work. continue to be the copyright owner and allow the journal to publish the article with the CC BY-NC-SA license receiving a DOI (Digital Object Identifier) of the work.
