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

Abstract

We report a 38-year-old female patient affected with anti-citrullinated protein antibody (ACPA)-positive rheumatoid arthritis (RA) who developed mild hemolytic anemia (Hb = 10.5 vs. >12 gr/dL), indolent oral ulceration, ANA (1:1280, homogeneous pattern), and anti-dsDNA antibody positivity following 8 months of therapy with an adalimumab biosimilar (GP2017). Rhupus syndrome was diagnosed. Replacing GP2017 with infliximab, anemia, oral ulcer, and anti-dsDNA antibodies quickly disappeared, while low-titers (1:80) ANA are still present after more than a year. The possibility that the patient suffered from rhupus rather than drug-induced lupus erythematosus associated to anti-ACPA positivity RA was discussed. To date, after a 14-month follow-up, no manifestations of LE have reappeared. To the best of our knowledge, this is the first report of adalimumab-induced rhupus.

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

“…[10,14,15] (Table 3). In the same systematic review, 202 of 287 patients were identified with hematological abnormalities, but only a few instances showed autoimmune hemolytic anemia, the majority of which had favorable outcomes [10,[16][17][18][19][20][21][22] (Table 3). Our patient was diagnosed with an overlap between RA and SLE based on clinical signs and symptoms and serological findings, and her illness was complicated by lupus nephritis, autoimmune hemolytic anemia, and CNS vasculitis, which improved following administration of steroids, hydroxyquinone, and cyclophosphamide.…”