BackgroundConcomitant presence of two autoimmune diseases, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) is known as Rhupus. Despite, poliautoimmunity is not uncommon described in patients with systemic autoimmune diseases, only a small series of patients have been described so far with Rhupus. Our purpose was to analyze clinical and serological characteristics of patients with Rhupus and compare them with a cohort of patients with SLE.MethodsIn this cross-sectional study, we included cases of Rhupus (RA-ACR/EULAR 2010 plus SLE-ACR 1987 criteria) from different Rheumatology Departments at Catalonia, Spain. In addition, we included patients with diagnosis of SLE in a 2:1 ratio matched by sex and race. All information was recorded following an established protocol.Abstract 217 Table 1General characteristics of Rhupus and SLE patients Rhupus (n= 19) SLE (n= 38) P value Gender (Female), % 17 (89.5) 36 (94.7) 0.59 Mean age, years±SD 56.9±12.8 45.9±12.3 0.03 Disease duration, years±SD 13.9±7.0 10.5±9.7 0.24 Race (Caucasian), % 14 (73) 27 (71.1) 0.89 Clinical characteristics Oral ulcers,% 2 (10.5) 16 (42.1) < 0.01 Articular involvement, % 19 (100) 36 (94.7) < 0.01  • Arthritis, % 19 (100) 29 (76.3) 0.02  • Erosive disease, % 11 (57.9) 1 (2.6) < 0.01  • Tenosynovitis, % 10 (52.6) 19 (26.3) 0.05 Leukopenia, % 3 (15.8) 21 (55.3) < 0.01 Renal involvement, % 1 (5.3) 10 (26.3) 0.07 Mean SLEDAI * 1.2±1.6 3.3±3.4 0.03 Immunological features Mean RF levels, IU±SD 184.6±199.3 47.6±114.5 < 0.01 Mean anti-CCP titers, IU±SD 622.3±908.5 5.1±5.2 < 0.01 Positive anti-Ro antibodies, % 15 (18.9) 17 (48.6) 0.03 Treatment (ever) Prednisolone, % 19 (100) 28 (75.7) 0.02 Methotrexate, % 17 (89.5) 13 (36.1) < 0.01 Rituximab, % 8 (44.4) 5 (14.7) 0.04 * Last visitResultsA total of 57 patients were included, 19 cases with Rhupus and 38 cases of SLE alone as controls. 93% of patients were female, Caucasian represented 71.4%, Mestizo 17.9% and 5.4% were Asian. Mean age was 48.6±13.5 years and mean disease duration was 11.48±9.1 years. Main clinical characteristics were cutaneous involvement (75.0%), hematological (66.0%), serositis (19.3%), renal disease (17.9%) and secondary Sjögren syndrome (28%) among others. Clinical and serological characteristics according groups are shown in table 1.ConclusionsWe found some clinical and serological differences among patients with Rhupus and SLE alone. As expected, articular domains and titers of RF and ACPAs were higher in Rhupus and they are more commonly treated with methotrexate and rituximab. By other hand, leukopenia, oral ulcers, anti-Ro antibodies and higher SLEDAI score were more common among SLE patients. Whether Rhupus patients represent a different condition requires further analysis in bigger cohorts.

Background:Concomitant presence of two autoimmune diseases, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) is known as “Rhupus”. Although poliautoimmunity is not uncommon phenomenon, only a small series of patients have been described so far with Rhupus.Objectives:Our purpose was to analyze the clinical and serological characteristics of patients with Rhupus and compare them with a cohort of patients with SLE.Methods:In this cross-sectional study, we included cases of Rhupus (ACR/EULAR 2010 plus ACR 1987 criteria) from 11 different Rheumatology Departments at Catalonia, Spain. We included patients with a diagnosis of SLE in a 2:1 ratio matched by sex, race and disease duration. To avoid misclassification, those patients with Rhupus but who had Jaccoud’s arthropathy or with overlap syndromes were excluded.Results:A total of 120 patients were included, 40 cases with Rhupus and 80 cases with SLE. Most of patients were female (95%) and Caucasian (75%). Mean age was 51.0 ± 14.7 years with a mean disease duration of 12.9 ± 9.2 years. Main clinical characteristics were articular involvement (93.3%), cutaneous involvement (77.5%), haematological (72.5%), secondary Sjögren syndrome (38.7%) among others. Clinical and serological characteristics according different groups are shown in Table. Total N= 120 Rhupus n = 40 SLE n = 80 Gender (Female),%114 (95%)38 (95%)76 (95%) 1Mean age, years ± SD51,0 ± 14,757,10 ± 14,1§ 47,9 ± 14,2Disease duration, years ± SD12,9 ± 9,213,6 ± 7,912,6 ± 9,8Race (Caucasian),%84 (75%)25 (78,1%)59 (73,8%) Clinical characteristics Cutaneous involvement,%93 (77,5%)31 (77,5%)62 (77,5%)Articular involvement,%112 (93,3%)40 (100%) § 72 (90,0%)· Arthritis,%96 (80,0%)40 (100%) §§ 56 (70,0%)· Erosive disease,%25 (20,8%)24 (60,0%) §§ 1 (1,3%)· Tenosynovitis,%37 (30,8%)22 (55,0%) §§ 15 (18,8%)Renal involvement,%24 (10%)4 (10,0%) § 20 (25,0%)Mean SLEDAI *2,9 ± 2,82,6 ±2,53,0 ± 3,0 Immunological features Positive RF,%37 (32,7%)32 (80%) §§ 6 (6,8%)Positive anti-CCP,%33 (30,6%)31(81,6%) §§ 2 (2,9%)Comorbidity ¥ 44 (36,7%)20 (50,0%) § 24 (30,0%)SLICC *0,8 ± 1,361,3 ± 1,55 §§ 0,6 ±1,2 Treatment (ever) Prednisolone,%100 (84,7%)39 (97,5%) §§ 61 (78,2%)Antimalarial109 (91,6%)35 (89,7%)74 (92,5%)MTX%58 (48,7%)33 (82,5%)§§ 25 (31,6%)Rituximab,%24 (20,2%)13 (33,3%)§ 11 (13,8%)* Last visit, ¥ Comorbidities included: Hypertension, DM, dyslipemia, osteoporosis or Cushing.Conclusion:We found some clinical and serological differences among patients with Rhupus vs SLE alone. As expected, articular domains and positive RF and ACPAs were higher in Rhupus. By other hand, renal involvement was more common among “pure” SLE patients. Rhupus patients were more commonly treated with prednisolone, MTX and rituximab, and had more comorbidities and organ damage. If Rhupus represent a different condition, requires further analysis in bigger cohorts.Disclosure of Interests:Beatriz Frade Sosa: None declared, J. Narváez Consultant for: Bristol-Myers Squibb, Tarek Carlos Salman Monte: None declared, Vera Ortiz Santa...