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214 Rhupus syndrome : a case report and literature review
  1. A Fikry and
  2. P Faridin
  1. Hasanuddin University, Internal Medicine, Makassar, Indonesia

Abstract

Background and aims Systemic lupus erythematosus (SLE) is an autoimmune and inflammatory disease with multiple clinical manifestations including arthropathy. The severity of the articular involvement or deformity to an erosive deforming arthropathy with severe functional disability. In rare cases a severe, erosive and deforming arthropathy, clinically indistinguishable from rheumatoid arthritis (RA) can be observed; this clinical entity is traditionally known as “Rhupus”. It remains controversial whether Rhupus is a distinct entity, an overlap between SLE and RA or a serious articular involvement of SLE.

Methods Observational.

Results A 23 years old female presented with polyarthritis, vasculitis, and anaemia. She was having symmetrical inflammatory polyarthritis of both upper and lower limb for last 2 years and was having skin rash for last 1 year. She also gave history of recurrent oral ulcers, photosensitivity and alopecia. On Investigation, revealed anaemia, alopecia, oral ulcer, vasculitis and active synovitis of both elbows, wrists, hands, knees and ankle joints. Her report showed raised of inflammatory parameter, normochomic normocytic anaemia. Further work up showed positive result in RF and anti-IgG. Also showed positive results on some antigens ANA profile. She was started on prednisolone, Metotrexate, folic acid, hydroxychloroquine, calcium, vitamin D and Natrium Diclofenac.

Conclusions Rhupus Syndrome is a rare syndrome. Currently, Rhupus remains an entity not perfectly known, but the pathogenesis, the autoantibody positivity, the radiological manifestations and therapy all support the idea that it is really an overlap syndrome between SLE and RA, although its pathogenesis still remains to be fully understood .

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