Navigating Rhupus Complexity

Year 2024, , 118 - 122, 27.09.2024

Dilara Bulut Gökten , Rıdvan Mercan

https://doi.org/10.5505/achmedj.2024.95967

Abstract

The term ‘Rhupus,’ introduced by Peter Schur in 1971, describes patients meeting criteria for both rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Rhupus (RhS) is a rare syndrome, and approximately 60 cases have been described in the literature to date. The challenges in diagnosing this disease stem from the lack of well-defined clinical criteria. In this case, we present a 42-year-old female patient with overlap syndrome of RA and SLE (RhS) who developed inflammatory arthritis, swelling in her bilateral wrists, severe malar rash, oral ulcers and alopecia, anemia and thrombocytopenia during follow-up. Upon arrival, the patient’s laboratory values were as follows: erythrocyte sedimentation rate: 61 mm/hour (normal value: 0-20), hemoglobin: 8.3 g/dL (12-16), platelet count: 112.103/μL (150-450.103/μL). The purpose of documenting this case is to share our own experience with a syndrome that is quite rare and has the potential to cause confusion in the daily practice of clinicians.

Keywords

Lupus, Rheumatoid arthritis, SLE, Rhupus

References

• 1. Alfadhli S, Nizam R. Rhupus: A crosswalk between lupus and rheumatoid arthritis. OA Arthritis. 2014;10:2.
• 2. Schur P. Cecil-loeb textbook of medicine. 1971.
• 3. Simón JA, Granados J, Cabiedes J, Morales JR, Varela JA. Clinical and immunogenetic characterization of Mexican patients with ‘rhupus’. Lupus. 2002;11(5):287-92.
• 4. Solis Cartas U, Martínez Larrarte JP, Prada Hernández DM, Gómez Morejón JA, Valdés González JL, Molinero Rodríguez C. Rhupus syndrome. A rare combination. Revista Colombiana de Reumatología. 2017;24(4):237-41.
• 5. Pipili C, Sfritzeri A, Cholongitas E. Deforming arthropathy in systemic lupus erythematosus. Eur J Intern Med. 2008;19(7):482-7.
• 6. Agha RA, Franchi T, Sohrabi C, Mathew G, Kerwan A, Thoma A, et al. The SCARE 2020 guideline: updating consensus surgical CAse REport (SCARE) guidelines. International Journal of Surgery. 2020;84:226-30.
• 7. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, 3rd, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569-81.
• 8. Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey-Goldman R, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Annals of the Rheumatic Diseases. 2019;78(9):1151-9.
• 9. Iaccarino L, Gatto M, Bettio S, Caso F, Rampudda M, Zen M, et al. Overlap connective tissue disease syndromes. Autoimmun Rev. 2013;12(3):363-73.
• 10. Benavente EP, Paira SO. [Rhupus: report of 4 cases]. Reumatol Clin. 2011;7(5):333-5.
• 11. Ziaee V, Moradinejad MH, Bayat R. RHUPUS Syndrome in Children: A Case Series and Literature Review. Case Rep Rheumatol. 2013;2013:819629.
• 12. Pichilingue GS, Campos JG, Zevallos JC. Características clínicas y hallazgos histopatológicos de glomerulonefritis lúpica en pacientes con Rhupus en el Hospital Nacional Arzobispo Loayza en los años 2003 al 2009. Acta Médica Peruana. 2011;28(2):79-81.
• 13. Shovman O, Langevitz P, Shoenfeld Y. Rhupus; unusual presentations. Clin Rheumatol. 2015;34(12):2041-6.
• 14. Orozco G, Eyre S, Hinks A, Bowes J, Morgan AW, Wilson AG, et al. Study of the common genetic background for rheumatoid arthritis and systemic lupus erythematosus. Ann Rheum Dis. 2011;70(3):463-8.
• 15. Chan MT, Owen P, Dunphy J, Cox B, Carmichael C, Korendowych E, McHugh NJ. Associations of erosive arthritis with anti-cyclic citrullinated peptide antibodies and MHC Class II alleles in systemic lupus erythematosus. The Journal of Rheumatology. 2008;35(1):77-83.
• 16. Tani C, D’aniello D, Delle Sedie A, Carli L, Cagnoni M, Possemato N, et al. Rhupus syndrome: assessment of its prevalence and its clinical and instrumental characteristics in a prospective cohort of 103 SLE patients. Autoimmunity reviews. 2013;12(4):537-41.
• 17. Seo SR, Lee SJ, Park DJ, Kim TJ, Park YW, Lee SS. Successful treatment using cyclosporine in a patient with rhupus complicated by aplastic anemia: a case report and review of the literature. Clin Exp Rheumatol. 2011;29(4):708-11.
• 18. Andrade-Ortega L, Irazoque-Palazuelos F, Muñóz-López S, Rosales-Don Pablo VM. Efficacy and tolerability of rituximab in patients with rhupus. Reumatol Clin. 2013;9(4):201-5.
• 19. Pinto LF, Velásquez CJ, Prieto C, Mestra L, Forero E, Márquez JD. Rituximab induces a rapid and sustained remission in Colombian patients with severe and refractory systemic lupus erythematosus. Lupus. 2011;20(11):1219-26.