Rhupus Syndrome: Overlap of Rheumatoid Arthritis and Systemic Lupus Erythematosus

Abstract

Rhupus syndrome is a rare and incompletely described autoimmune entity in which the same patient sequentially develops symptoms both of Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE). Both diseases have different diagnostic criteria and laboratory investigations but have mixed clinical presentation so can easily miss the rhupus syndrome. Overlap phenomenon is common in various autoimmune diseases which otherwise differ in presentation, treatment response and prognosis. RA and SLE overlap is very rarely reported and no rational criteria for its diagnosis and treatment strategy are finalized yet. In most of the reported cases of Rhupus syndrome, RA appeared first and SLE developed later while in a small number of cases SLE appeared first which later evolved to RA and in a few cases symptoms of both diseases appeared simultaneously. A 55-years old female patient was diagnosed with RA four years back and recently developed oral ulcers, anemia, leucopenia and thrombocytopenia. After complete history, general physical examination, laboratory investigations and fulfillment of SLE (SLICC criteria 2012) and (ACR criteria 2010) for RA, a final diagnosis of Rhupus syndrome was established.