Overlap syndrome of systemic lupus erythematosus and rheumatoid arthritis (“rhupus”) with systemic involvement – A rare case report

Abstract

A 43 year old female, known hypothyroidism, presented with chest pain, breathlessness, without fever or rash, since 15 days. She had multiple joint pains since 11 months. Distal interphalyngeal joints were spared. She had hand deformities and tenderness in the metacarpophalyngeal and proximal interphalyngeal joints of all 10 fingers and both hips and knees. 2D-echo showed Pulmonary Hypertension. High resolution computed tomography of thorax showed non-specific interstitial pneumonia. She had anemia, raised C - reactive protein, positive indirect Coomb’s test. Her Anti-Nuclear antibody, rheumatoid factor, anti-Sm, anti-Sm/RNP and anti-Ro antibodies were positive. Her anti-Citrullinated peptide antibody was negative. As she satisfied the diagnostic criteria for both lupus and rheumatoid arthritis, she was diagnosed as a case of rhupus syndrome. She was treated with pulse injectable methylprednisolone for 3 days and then shifted to oral prednisone, along with hydroxychloroquine, oral methotrexate, sildenafil, pirfenidone and torsemide-spironolactone.