Erosive rheumatoid arthritis co-existing with systemic lupus erythematosus. A report of a case, also showing atlanto-axial subluxation

Abstract

A 28-year old female is described with a 12-year history of seropositive, erosive rheumatoid arthritis. Subsequently, she developed systemic lupus erythematosus diagnosed both serologically and on renal biopsy. As has previously been emphasised, these two diseases occur rarely in the same patient. HLA typing revealed the patient was HLA - B8 positive and that she had inherited this genetic marker from her mother who is Irish, rather than from her West Indian father. The patient has developed marked atlanto-axial subluxation, a feature not noted in six patients previously described as having both diseases.

Rhupus arthropathy as the presenting manifestation in Juvenile SLE: a case report

“…Brzezinska reported a case with coexistence of RA and SLE in 1973 [8], and Meijers [9] presented a case with chronic synovitis as an unusual manifestation of SLE, in 1978. Fishman [10] in 1981 and Isenberg [11] in 1982 reported cases, which had RA as an initial diagnosis, and they were classified as SLE after many years. Tauchi demonstrated the coexistence of the two diseases in 2 sisters, who also had Marfan syndrome, in 1985 [12].…”

Unusual case of tetraparesis in a patient with systemic lupus erythematosus

“…12 We found only 10 cases of atlantoaxial subluxation complicating SLE reported in the literature. 1,[3][4][5] This said, the condition might be underdiagnosed (in asymptomatic or paucisymptomatic patients) and the prevalence therefore underestimated. Thus, a systematic search for atlantoaxial subluxation was performed, by conventional flexion/ extension cervical spine X-rays, in a series of 59 SLE patients, of which 8.5% tested positive.…”

“…7,8 Interestingly, this condition has been described in so-called ‘rhupus’ overlap cases, in which serum anti-CCP Ab is typically detected. 2,4 The diagnosis of mixed connective disease was obviously considered but disregarded, despite the presence of anti-RNP antibodies, based on the history of pleuritis, pericarditis and biopsy-proven lupus proliferative glomerulonephritis, with strikingly elevated high-affinity anti-DNA antibodies measured by Farr assay.…”