A comparative study on clinical and serological characteristics between patients with rhupus and those with systemic lupus erythematosus and rheumatoid arthritis

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> The concomitant presence of two autoimmune diseases – systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) – in the same patient is known as rhupus. We evaluated a group of patients with rhupus to clarify further their clinical, serological and immunogenic features in a multi-centre cohort. In addition, the study aimed to explore the utility of the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) SLE classification criteria in our group of patients with rhupus. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> This was a cross-sectional study. We included rhupus patients from 11 different rheumatology departments, and compared them to SLE and RA patients at a ratio of 2:1. All information was recorded following a pre-established protocol. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> A total of 200 patients were included: 40 rhupus patients and 80 each of SLE and RA patients as controls. Disease duration was similar among SLE and rhupus groups (around 13 years), but the RA group had a significantly lower disease duration. Main clinical manifestations were articular (94.2%), cutaneous (77.5%) and haematological (72.5%). Rhupus patients had articular manifestations similar to those expected in RA. Only 10% of rhupus patients had renal involvement compared with 25% of those with SLE ( p &lt; 0.05), while interstitial lung disease was more common in patients affected by RA. The 2019 EULAR/ACR SLE criteria were met in 92.5% of the rhupus patients and in 96.3% of the SLE cohort ( p &gt; 0.05). Excluding the joint domain, there were no differences between the numbers of patients who met the classification criteria. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Rhupus patients follow a particular clinical course, with full expression of both SLE and RA in terms of organ involvement, except for a lower prevalence of kidney affection. The new 2019 EULAR/ACR SLE criteria are not useful for differentiating SLE and rhupus patients. A new way of classifying autoimmune diseases is needed to identify overlapping clusters. </jats:p></jats:sec>

Potential Benefit of Rituximab in Rhupus Patients From a Single-Center

“…Thus, our approach was coherent with the current view, supported by the presence of specific immunological biological markers of the 2 diseases. 1 Taken together, our data are concordant with those recently reported by Frade-Sosa et al 11 who found that the main clinical manifestations of rhupus were articular (94%), cutaneous (77.5%), and hematological (72.5%). The single difference was a lower prevalence of kidney involvement (10%), whereas ours was quite similar to that found in SLE (25%).…”

“…The single difference was a lower prevalence of kidney involvement (10%), whereas ours was quite similar to that found in SLE (25%). 11 Regarding SLE, the profile of our patients, characterized by a longstanding disease with mainly articular pattern, satisfying both SLE sets of criteria or one of them, is in accordance with the findings of a recent study. 12 However, we cannot exclude induction of SLE manifestations by infliximab (n = 2) or etanercept (n = 1) prescribed in first line for 3 patients who had an initial diagnosis of RA before SLE occurrence.…”

Adalimumab-Induced Rhupus Syndrome in a Female Patient Affected with Anti-Citrullinated Protein Antibody (ACPA)-Positive Rheumatoid Arthritis (RA): A Case Report and Review of Literature

“…In general, rhupus patients may present with any of the systemic manifestations of LE. However, a multicentric comparative study on clinical and serological characteristics between patients with rhupus and those with LE and RA reported that the main LE-like clinical manifestations in rhupus patients were cutaneous manifestations (oral ulcerations are among these), hematological manifestations, and serositis [26], so confirming data already reported by other investigators [3]. It is worth pointing out that these two studies had by far the most numerous casuistry.…”

A Rare Case of Rhupus Syndrome With Systemic Involvement: A Case Report and Literature Review

“…Previous studies on rhupus patients revealed that RA symptoms and signs predominate over SLE-related organic damage, and the main symptom is erosive arthropathy [ 6 , 7 ]. However, it can manifest any of the typical SLE symptoms, including photosensitivity, serositis, vasculitis, or glomerulonephritis [ 6 ]. Unfortunately, the absence of official classification criteria places rhupus patients at a disadvantage and makes it challenging to classify them [ 6 ].…”

“…However, it can manifest any of the typical SLE symptoms, including photosensitivity, serositis, vasculitis, or glomerulonephritis [ 6 ]. Unfortunately, the absence of official classification criteria places rhupus patients at a disadvantage and makes it challenging to classify them [ 6 ]. In most cases, the prognosis of rhupus syndrome is determined by the degree of the organic damage, with a higher proportion having a worse long-term prognosis [ 6 ].…”