(Kiosk 2) A Lone Case of Rhupus: A Case Presentation

Case Diagnosis: Rhupus a coexisting manifestation of rheumatoid arthritis and systemic lupus erythematosus.

Case Description: A 36-year-old black female with a past medical history of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), hypertension, deep vein thrombosis, depression, and recently alopecia was admitted for suspected lupus flare management. She presented with symptoms of chest pain radiating to the left shoulder, myalgia, and polyarthralgia with joint effusions for the past 4 days. She also had memory fog, sensitivity to light, blurriness, and right-sided frontotemporal headache. She was managed with intravenous corticosteroids and her home medication of azathioprine and hydroxychloroquine.

Discussion: Rhupus is typically a rare presentation of coexisting SLE and RA. SLE-associated arthritis, previously defined as non-erosive arthritis until guidelines in 2012, stated that SLE-synovitis is characterized by swelling, effusion, or tenderness of >2 joints with >30 minutes of morning stiffness. Jaccoud arthropathy is a subset of SLE-associated arthritis. It is a reversible joint deformity that can progress to erosions different from RA. However, patients with Rhupus typically have a higher degree of erosion in their joints than just SLE alone, resembling the erosion of RA. Rhupus encompasses clinical and laboratory findings of RA and SLE. There is mixed literature surrounding the disease presentation order. However, symptoms typically present sequentially. There are currently no diagnostic criteria for Rhupus. Therefore, patients with fast disease progression, significant symmetric joint erosion, reducible joint deformity, or systemic symptoms should be worked up for the concurrent process of Rhupus

Setting: Inpatient hospital

Assessment/Results: The patient was ultimately diagnosed with an actual overlap of RA and SLE, resulting in Rhupus.

Conclusion: Rhupus is an essential condition to consider in patients presenting with polyarthritis in the setting of SLE, as prompt treatment can delay and slow the progression of the disease, decreasing the patient’s impairments.