Dual seropositive nonerosive lupus arthritis: rhupus or not?

IF 2.1 4区 医学 Q3 RHEUMATOLOGY
Mete Pekdiker, Mete Kara
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Abstract

Background: There is no consensus on the classification of lupus arthritis (LA). In this study, we aimed to investigate patients with LA who were clinically and serologically very similar to those patients with rheumatoid arthritis (RA).

Methods: The electronic medical files of systemic lupus erythematosus (SLE) patients from a single tertiary rheumatology department between 2017 and 2022 were reviewed. The inclusion criteria were being age ≥ 18 years, having nonerosive peripheral arthritis lasting longer than six months, and having dual seropositive (rheumatoid factor (RF) and anti-citrullinated protein antibody (anti-CCP)) serology. A nonerosive course of arthritis was demonstrated by both conventional radiography and joint ultrasound. Images were assessed by two blinded rheumatologists. Patients with drug-induced lupus and those with other rheumatologic diseases were excluded.

Results: The cases of 528 patients were reviewed, and eight patients were included in the study. All patients were female, and the median age was 48.5 years. The median SLE and arthritis durations were 12 and seven years, respectively. The most common SLE symptom was photosensitivity (n = 8). Only one patient had life-threatening involvement (LTI), which was a seizure and autoimmune haemolytic anaemia. All patients had arthritis affecting the wrist and hand. Anti-dsDNA was the most common anti-ENA antibody (n = 7), followed by anti-SSA (n = 5). The median RF and anti-CCP titres were 82.5 IU/ml and 81.5 U/ml, respectively. Five patients had high titres of autoantibodies, and only one patient had slight hypocomplementemia. Three patients needed biologic agents, and remission was achieved after treatment with rituximab.

Conclusion: Despite a long arthritis duration and dual seropositive serology with high titres of RF and anti-CCP, our patients had SLE rather than rhupus syndrome. The low frequency of LTIs, such as lupus nephritis, was a remarkable feature of our patients. Lupus arthritis may be clinically and serologically indistinguishable from RA. Prospective studies are needed to better define LA.

双血清阳性非糜烂性狼疮关节炎:是不是狼疮?
背景:狼疮关节炎(LA)的分类尚无共识。在这项研究中,我们旨在调查临床和血清学上与类风湿关节炎(RA)患者非常相似的LA患者。方法:回顾性分析某三级风湿病科2017 - 2022年系统性红斑狼疮(SLE)患者的电子病历。纳入标准为年龄≥18岁,非糜烂性外周关节炎持续时间超过6个月,血清学双阳性(类风湿因子(RF)和抗瓜氨酸化蛋白抗体(anti-CCP))。常规x线摄影和关节超声显示关节炎无糜烂性病程。图像由两位盲法风湿病学家评估。排除药物性狼疮患者和其他风湿病患者。结果:回顾性分析528例患者,纳入8例患者。所有患者均为女性,中位年龄48.5岁。SLE和关节炎的中位病程分别为12年和7年。最常见的SLE症状是光敏性(n = 8)。只有一个病人有危及生命的介入(LTI),这是癫痫发作和自身免疫性溶血性贫血。所有患者均患有手腕和手部关节炎。抗ena抗体中最常见的是抗dsdna (n = 7),其次是抗ssa (n = 5)。中位RF效价和抗ccp效价分别为82.5 IU/ml和81.5 U/ml。5例患者有高滴度的自身抗体,只有1例患者有轻微的补体不足。3例患者需要生物制剂,利妥昔单抗治疗后缓解。结论:尽管关节炎病程长,血清双阳性,RF和anti-CCP高滴度,但我们的患者是SLE而不是rhupus综合征。低频率的LTIs,如狼疮性肾炎,是我们患者的显著特征。狼疮关节炎可能在临床和血清学上与类风湿性关节炎难以区分。需要前瞻性研究来更好地定义LA。
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来源期刊
Advances in Rheumatology
Advances in Rheumatology Medicine-Rheumatology
CiteScore
4.00
自引率
4.30%
发文量
41
审稿时长
53 weeks
期刊介绍: Formerly named Revista Brasileira de Reumatologia, the journal is celebrating its 60th year of publication. Advances in Rheumatology is an international, open access journal publishing pre-clinical, translational and clinical studies on all aspects of paediatric and adult rheumatic diseases, including degenerative, inflammatory and autoimmune conditions. The journal is the official publication of the Brazilian Society of Rheumatology and welcomes original research (including systematic reviews and meta-analyses), literature reviews, guidelines and letters arising from published material.
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