Coexistence of RA and SLE - is it rare?

[Guest guest]

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

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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@...

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

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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. "

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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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Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[Guest guest]

http://www.lupus.org/education/brochures/connective.html

With all these conflicting opinions, how can we trust ANY diagnosis. ? There

just isn't enough known about auto-immune diseases, to get an absolute dx.

Patsy (63) AZ

DX 2005 Stage 1 PBC

AIH/SLE/RA