Efficacy of Abatacept for Arthritis in Patients with an Overlap Syndrome between Rheumatoid Arthritis and Systemic Lupus Erythematosus

Abstract

Introduction. This study aimed to investigate the efficacy of abatacept for arthritis in patients with rhupus, an overlap syndrome between rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Methods. Patients who fulfilled both the 2010 ACR/EULAR criteria for RA classification and the 1997 ACR revised criteria for classification of SLE and received abatacept treatment for arthritis were retrospectively studied. Results. Six rhupus patients who fulfilled the inclusion criteria above were identified. All patients had active arthritis despite receiving antirheumatic drugs including methotrexate when abatacept was initiated. Clinical Disease Activity Index (CDAI) significantly decreased between baseline and 12 weeks (P = 0.028) and remained low through 24 weeks. All patients achieved either a good or moderate response according to the EULAR response criteria at 24 weeks. Health Assessment Questionnaire-Disability Index (HAQ-DI) also significantly decreased between baseline and 24 weeks (P = 0.043). In addition, the levels of immunoglobulin G and anti-DNA antibody significantly decreased between baseline and 24 weeks (P = 0.028 and P = 0.043, resp.). Conclusions. Treatment with abatacept is likely to be efficacious in patients with rhupus whose arthritis is refractory to methotrexate. In addition, abatacept may have a moderate effect on abnormal antibody production in rhupus patients.

Ultrasonographic assessment of bone erosions in the different subtypes of systemic lupus erythematosus arthritis: comparison with computed tomography

“…A classification system could be particularly helpful in order to provide targeted therapies to patients at risk of developing erosive or deforming arthritis as a major cause of disability. An increasing number of scientific reports suggest, in fact, that patients with rhupus syndrome may take advantage of anti-CD20 [ 30 ] or anti-CTL4 [ 31 ] biologic drugs, whereas TNF-alpha blockers are discouraged [ 32 ]. On the other hand, JA has been suggested to be a late complication of NDNE arthritis, characterized by high IL-6 and C-reactive protein and sub-clinical inflammation [ 11 , 14 , 33 ], and therefore, may benefit from early anti-BLyS [ 34 ] or anti-IL-6 treatment.…”

Rhupus; unusual presentations

“…During the abatacept treatment, the CDAI decreased significantly along with a decrease in anti-DNA antibodies [32]. Therefore, the possible treatment algorithm in Rhupus patients may include the following: first of all, the use of conventional DMARDs and in some resistant cases the treatment should be followed by rituximab and abatacept.…”

Long-term efficacy and safety of antitumour necrosis factor alpha treatment in rhupus: an open-label study of 15 patients

“… 18 19 Abatacept was used in six Japanese patients with rhupus in whom the Clinical Disease Activity Index significantly decreased between baseline and 12 weeks, and all patients achieved a good or moderate response according to the EULAR response criteria. 21 The DAS 28 decreased from 6.2 to 3.6 in three other patients treated by abatacept. 19 Regarding tolerance with rituximab, one severe and nine non-serious infectious events have occurred in six patients in the first study in 24 months’ follow-up, 16 and other adverse events are related to perfusion.…”