Rhupus Syndrome is a rare condition where patients exhibit symptoms of both rheumatoid arthritis (RA) and Systemic Lupus Erythematosus (SLE) and its prevalence is estimated to be around 0.09%. It's characterised by the co-occurrence of erosive polyarthritis, similar to RA, along with typical SLE symptoms and specific autoantibodies.
Symptoms:
Patients with rhupus experience symptoms of both RA - joint pain, stiffness and swelling, especially in the hands and feet, rheumatoid nodules - lumps under the skin at the site of the affected joint) and SLE - photosensitivity, oral ulcers, hair loss fatigue, fever and malar rash. A key feature of rhupus is the erosive nature of the arthritis, meaning it can damage the joints and lead to deformities.
Diagnosis:
Diagnosing rhupus can be challenging due to the overlap of symptoms with other rheumatic diseases. Diagnosis is made through a combination of clinical findings, laboratory tests, and imaging studies. It often involves assessing for symptoms of both RA and SLE, along with specific antibody profiles and imaging features.
Treatment:
Rhupus requires a multifaceted treatment approach. It often involves a combination of medications, lifestyle adjustments and potentially biologics, tailored to the individual's specific symptoms and disease severity. As with lupus, treatment for rhupus is individualised and may need to be adjusted over time as the patient's condition changes.
• Corticosteroids: Low to moderate doses of corticosteroids are frequently used, particularly for patients with prominent joint involvement, to prevent the progression of erosive arthritis.
• Disease-Modifying Anti rheumatic Drugs (DMARDs): These are crucial for managing both RA and SLE components. Commonly used DMARDs include:
• Methotrexate: A frequently prescribed DMARD for rhupus, often in combination with other medications.
• Hydroxychloroquine: Used for fatigue and skin and joint problems.
• Sulfasalazine, Azathioprine, and Leflunomide: These are other DMARD (disease-modifying anti-rheumatic drug) options that may be used in rhupus treatment. Sulfasalazine may be associated with an increased risk of allergic skin reactions and can rarely cause lupus like syndromes so it is used with cautions with patients with SLE.
• JAK inhibitors (Tofacitinib and Upadacitinib): These are also being used to treat rhupus, according to a study published in The Journal of Rheumatology.
Lifestyle Modification:
Sun Protection: Sunscreen with a high SPF (at least 50) and protective clothing are essential to minimise skin damage from sunlight.
Activity Pacing: Balancing activity with rest is important to manage fatigue and protect joints.
Stress Management: Relaxation techniques and other stress-reducing methods can help manage overall symptoms.
Healthy Diet: A balanced diet, including vitamin D and calcium supplementation, can support overall health.
Avoid Smoking: Smoking can exacerbate the effects of lupus on the heart and blood vessels.
Prognosis:
The prognosis of rhupus is typically better than SLE but worse than RA, with outcomes depending on the severity of organ involvement.
RA Dominance: Rhupus often presents with a more prominent RA phenotype, characterised by symmetrical erosive polyarthritis and joint deformities.
Milder SLE Manifestations: Compared to SLE alone, rhupus patients may exhibit less kidney and neurological involvement, and a lower SLE Disease Activity Index.
Potential for Severe SLE: Despite milder SLE features, severe SLE-related complications like heart, lung, or kidney damage can still occur, though less frequently than in SLE alone.
Impact on Quality of Life: Neurological and haematological involvement, as well as joint damage, can significantly impact a patient's quality of life.
Need for Early Diagnosis and Treatment: Accurate diagnosis and appropriate treatment are crucial for managing rhupus and minimising potential complications.
