Re: Coexistence of RA and SLE - is it rare? how about

[Guest guest]

a friends sister has aggressive MS and now she has also been dx'ed RA Is this

common?

I was dx'ed SLE 25 years ago. I had skin problems, swelling problems, (not my

face- not the wolf rash thing) I had some foot problems on occasion. I sorta

slid the dx into the background and ignored it- except It took me 14 pregnancies

to have 3 kids.

It was a few years ago after I had vaccinations that my RA jumped into the

picture. Hard fast intense, far more intense than others I know here. BUT- none

of my docs have ever been very aggressive with tests or treatment for anything.

I have only had RA factor, ANA, sed rate, CRP labs- and Xrays of fingers and

toes- nothing else. I was trialed on Sulindec, Arthrotec, and then MTX. NOthing

else. I did have a short one time prednisone- a week long, low dose- to bring

relief - but doc said he would only allow me the one time on it. It helped SO

much- I swear in spite of the side effects, I would maybe sell my soul for it on

a bad day. DOes this mean I really probably do not have RA AND SLE?

- In , " " <Matsumura_Clan@m...> wrote:

> Coexistence of RA and SLE - is it rare?

>

>

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>

> An excerpt from a March 14, 2004 HealthTalk " Ask the Doctor "

> with Gardner, M.D.:

>

>

> Cheryl:

>

> I have lupus and rheumatoid arthritis. What are the best drugs for

> relief with the least side effects? My lupus is not causing any problems

> or pain, but my arthritis causes me pain and inflammation.

>

>

> Dr. Gardner:

>

> It is a rare person that has both RA and SLE. Sometimes people are

> mislabeled with one or the other because people with RA can have a

> positive test for lupus and visa versa. There is a condition called

> Sjogren's syndrome that I frequently see mislabeled as both diseases due

> to the presence of a positive ANA, the test for lupus and positive

> rheumatoid factor, the test for RA. I would check with your

> rheumatologist to make sure you have both. There are rare people who in

> fact have both and we call it " rhupus. " Many medications treat both

> including methotrexate, hydroxychloroquine, azathioprine, leflunomide

> and prednisone. Currently one should avoid the TNF inhibitors due to the

> concern about making lupus worse although this remains to be proven.

>

> http://www.healthtalk.com/rheumatoidarthritis/askthedoctor/031504.cfm

>

>

> ****************************************

>

>

> Lupus. 2002;11(5):287-92.

>

>

> Clinical and immunogenetic characterization of Mexican patients with

> 'rhupus'.

>

> Simon JA, Granados J, Cabiedes J, Morales JR, Varela JA.

>

> Department of Immunology and Rheumatology, Instituto Nacional de

> Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, CP, Mexico DF.

> abrahamsimon@m...

>

> The coexistence of systemic lupus erythematosus and rheumatoid arthritis

> (rhupus) is a rare clinical condition. To date, 50 cases of rhupus have

> been described worldwide; however, the lack of clinical criteria for

> this rheumatic condition has created confusion in the characterization

> of this disorder. Nevertheless, in this paper we describe a

> comprehensive clinical and serological characterization of a cohort of

> 22 Mexican patients with rhupus, supported by generic HLA-DR

> phenotyping. We found that rhupus patients have a special clinical

> behavior. In this setting, the signs and symptoms of rheumatoid

> arthritis prevail, little organic damage associated with systemic lupus

> erythematosus (SLE) exists and none of the cases present thrombosis or

> morbidity during pregnancy in spite of presenting a high frequency of

> anticardiolipin antibodies. We also found an increased frequency of

> HLA-DR1 and HLA-DR2 alleles compared to healthy ethnically matched

> controls, systemic lupus erythematosus and rheumatoid arthritis

> patients.

>

> PMID: 12090562

>

>

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

2090562 & dopt=Abstract

>

>

> ****************************************

>

>

> From lupus expert Dr. Wallace's medical reference text " Dubois'

> Lupus Erythematosus " (2002):

>

> Chapter 46

> Differential Diagnosis and Disease Associations

>

> " Coexistence of Systemic Lupus Erythematosus and Rheumatoid Arthritis

>

> Do SLE and RA coexist? It has long been known that patients may start

> with a diagnosis of RA or SLE that becomes SLE or RA over a period of

> years. Assuming that MCTD is not present, however, the true coexistence

> of these conditions is rare. Despite the frequent clinical overlap

> between RA and SLE features, the combination of advanced, deforming,

> erosive RA and a significant degree of biopsy-proven SLE is an extremely

> unusual finding.

>

> Occasional case reports have appeared documenting a true coexistence. Of

> my own group's 464 patients with idiopathic SLE, one had classic

> seropositive, erosive, nodular RA with biopsy-documented proliferative

> SLE nephritis and nephrotic syndrome. The concurrence of SCLE in

> patients with RA who are Ro/SSA-positive is more common. Cohen and Webb

> reported the development of SLE in 11 Australian patients with typical

> RA who were observed over a 17-year period, but the total number of

> patients with RA followed was not stated. Brand et al. presented 11

> coexisting cases; most had class II genetic determinations of both

> disorders. Panush et al. have identified a true coexistence in six of

> 7,000 patients with RA who were evaluated over an 11-year period. It was

> concluded that rhupus did not occur more frequently than expected from

> the chance concurrence of SLE and RA (1.2%). Van Vollenhoven's group at

> Stanford found " rhupus " in 13 patients among 1,507 with RA and 893 with

> SLE. Seven appeared to have transformed from SLE to RA. "

>

>

>

> ****************************************

>

>

> Archives of Internal Medicine

> Vol. 148 No. 7, July 1, 1988

>

> 'Rhupus' syndrome

>

> R. S. Panush, N. L. , S. Longley and E. Webster

> Department of Medicine, College of Medicine, University of

> Florida.

>

> Occasionally patients with overlapping features of rheumatoid

> arthritis (RA) and systemic lupus erythematosus (SLE), termed " rhupus, "

> have been encountered. We wanted to ascertain the frequency of such

> patients and determine whether they represent a unique overlap syndrome.

> Of approximately 7000 new patients evaluated over 11 years, we

> identified six patients who had, on the average, 6.7 American Rheumatism

> Association criteria for RA and 4.2 criteria for SLE. Criteria for RA

> included chronic symmetric arthritis with morning stiffness (six

> patients); subcutaneous nodules (two patients); positive rheumatoid

> factors test (four patients); and radiologic erosions (four patients).

> The criteria for SLE included malar rash (three patients); discoid lupus

> erythematosus (two patients); biopsy-proved nephritis (one patient);

> photosensitivity (one patient); leukopenia/thrombocytopenia (four

> patients); positive antinuclear antibodies or lupus erythematosus cell

> test (six patients); hypocomplementemia (two patients); and abnormal

> results from skin biopsy (two patients). During observations of up to

> ten years, the conditions of three patients were stable or improved, one

> died, and two were unavailable for follow-up. Patients usually did not

> have conditions that evolved to classic rheumatic disease patterns.

> Rhupus was not common and did not occur more frequently (0.09%

> prevalence among our patients) than expected from chance concurrence of

> SLE and RA (calculated at 1.2%). These observations confirm that rhupus

> indeed exists as a syndrome manifested by patients sharing features of

> probable coincidental concurrence of RA and SLE, but not as a unique

> clinical pathologic or immunologic syndrome. Appreciation of these

> patients with rhupus is important since their therapy and outcome differ

> from those having RA or SLE alone.

>

>

http://archinte.ama-assn.org/cgi/content/abstract/148/7/1633?ijkey=3bdbcb16f360c\

02be00b65e7f1bd960252dee62c & keytype2=tf_ipsecsha

>

>

> ****************************************

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>

>

>

>

>

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org