Coexistence of ankylosing spondylitis and discoid lupus: A case report

Enginar, Ayşe Ünal; Nur, Hakan; Kaçar, Cahit

doi:10.14744/nci.2018.90922

Cited by 4 publications

(5 citation statements)

References 13 publications

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“…Thus, there have been reports of a variety of inflammatory skin responses such as erythema elevatum diutinum, discoid lupus and other vasculitides in patients with AS. [229][230][231] Pathomechanistically, they all seem to share a common pathway, with dysregulation of classic inflammatory cytokines such as IL-1, IL-12/23, IL-17 and IL-23. Common genetic factors like HLA-B27 are also typical in these cohorts.…”

Section: Resultsmentioning

confidence: 99%

Skin manifestations in spondyloarthritis

Meier

Schloegl

Poddubnyy

2020

Therapeutic Advances in Musculoskeletal

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Spondyloarthritides (SpA) like psoriatic arthritis, axial spondyloarthritis/ankylosing spondylitis, reactive arthritis and inflammatory bowel disease (IBD)-associated SpA can present with characteristic skin manifestations. These SpA-associated skin disorders may precede joint involvement, reflect a loss of efficacy of a current systemic treatment or can even be treatment associated. Cutaneous manifestations in SpA not only add additional morbidity with physical impact but also impose a psychosocial burden on affected patients. Psoriasis (PsO) – the main skin disease in SpA – has a variety of clinical presentations, including plaque-type PsO, inverse PsO, guttate PsO, erythrodermic PsO, nail PsO and pustular types. SpA associated with IBD presents with neutrophilic and granulomatous skin disorders, including pyoderma gangrenosum, hidradenitis suppurativa and cutaneous Crohn’s disease. Reactive arthritides has a favourable prognosis and may feature keratoderma blenorrhagicum or balanitis circinatum as typical skin manifestations. Immunologically, SpA-associated skin diseases share interleukin (IL)-17 and IL-23 dysregulation but show distinctive genetic and immunological profiles. Therefore, they vary in their treatment responses to targeted therapies with biologicals or small molecules. In this review, we highlight the clinical presentation of skin manifestations in SpA and discuss therapeutic approaches in this interdisciplinary field.

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Section: Resultsmentioning

confidence: 99%

Skin manifestations in spondyloarthritis

Meier

Schloegl

Poddubnyy

2020

Therapeutic Advances in Musculoskeletal

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“…4 In 2019, Enginar reported a case of spondyloarthritis with discoid lupus, with manifestation of both disorders at the same time of presentation. 5 Another case was reported by Tarhan in 2014, where a patient of SLE (biopsy-proven lupus nephritis) presented with spondyloarthritis manifestations 8 years after diagnosis of SLE. 7 Here the time frame may be comparable to the currently documented second case, but the patient was a young male who was diagnosed initially with lupus and diagnosed with spondyloarthritis after 10 years.…”

Section: Discussionmentioning

confidence: 99%

Ankylosing spondylitis with systemic lupus erythematosus: A rare co-existence

Chintala,

Jain,

Duggal

2022

IJRCI

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Systemic lupus erythematosus (SLE) and ankylosing spondylitis (AS) are two distinct immunological disorders with different etiopathogenic profiles and their co-existence is very rare. The present study discusses two cases of co-existing AS with SLE. The first case, which fulfilled the criteria for lupus, had HLA-B27 arthritis with predominant peripheral involvement, bilateral hip disease associated with non-scarring alopecia, recurrent oral ulcers and positive immunological markers. The second case was of a 37-year-old male with lupus (predominantly musculoskeletal and cutaneous) who presented with inflammatory low backache. The patient had high titers of ANA and anti-dsDNA positivity and was on methotrexate treatment. On evaluation, he was found to have HLA B27 positivity and bilateral active sacroiliitis. The distinguishing feature of both the cases was that the time frame of presentation of the disorders was almost same, while second case had a significant time frame between the two disorders.

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“…SLE usually develops as nonerosive arthritis; however, rhupus arthritis could be erosive as seen in the present study [ 20 ]. In another study, Benavente presented the clinical and serological characteristics of four rhupus patients [ 22 ]. They fulfilled ACR criteria for SLE and RA: ANA positive with titers ranging from 1/80 to 1/5250 and anti-ds-DNA, anti-CCP (3/4), and positive antiphospholipid antibodies in two patients (anticardiolipin and lupus anticoagulant) without manifestation APS.…”

Section: Discussionmentioning

confidence: 99%

“…One patient presented renal affection and 2 with subcutaneous nodules. Two patients were refractory to conventional DMARD and required biologics and mycophennolate mofetil [ 22 ]. Fernández et al reported eight patients with rhupus arthropathy; among them, three had erosive arthritis.…”

Section: Discussionmentioning

confidence: 99%

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Coexistence of Rheumatoid Arthritis, Systemic Lupus Erythematosus, Sjogren Syndrome, Antiphospholipid Syndrome, and Ankylosing Spondylitis

Khasru

Siddiq²,

Sayeeduzzaman

et al. 2021

Case Reports in Rheumatology

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A 37-year-old Bangladeshi woman presented with low back and several joints pain and swelling for months together; there was significant morning stiffness for more than two hours. Repeated abortions, dry eye, hair fall, photosensitivity, and oral ulcer were the additional complaints. Clinical examination unveiled asymmetrical peripheral and both sacroiliac joint tenderness, positive modified Schober’s test, and limited chest expansion. Schirmer’s test was positive. The history of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) among 1st-degree relatives was also significant. Biochemical analysis revealed pancytopenia, raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and mild microscopic proteinuria. The patient was seropositive for rheumatoid factor (RF), antibodies against cyclic citrullinated peptides (anti-CCP), antinuclear antibody (ANA), anti-Sm antibody, anti-Sjögren’s-syndrome-related antigen A and B (anti-SSA/SSB), antiphospholipid (aPL-IgG/IgM), and HLA B27; however, serum complement (C3 and C4) levels were normal. Basal cortisol level measured elevated. Besides, X-ray and MRI of lumbosacral spines demonstrated sacroiliitis. There was radiological cardiomegaly, echocardiography unveiled atrial regurgitation, and ascending aorta aneurysm. Based on the abovementioned information, RA, AS, and systemic lupus erythematosus (SLE) have been diagnosed. Moreover, the patient developed Sjogren’s syndrome (SS), antiphospholipid lipid syndrome (APS), Cushing syndrome, ascending aorta aneurysm, and atrial regurgitation. Her disease activity score for RA (DAS28), DAS for AS (ASDAS), SLE disease activity index (SLEDAI), and Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) scores were 3.46, 2.36, 23, and 5, respectively. The patient received hydroxychloroquine (200 mg daily), pulsed cyclophosphamide, prednisolone (20 mg in the morning), and naproxen 500 mg (twice daily). To our best knowledge, this is the first report documenting RA, AS, and SLE with secondary SS and APS.

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Coexistence of ankylosing spondylitis and discoid lupus: A case report

Cited by 4 publications

References 13 publications

Skin manifestations in spondyloarthritis

Skin manifestations in spondyloarthritis

Ankylosing spondylitis with systemic lupus erythematosus: A rare co-existence

Coexistence of Rheumatoid Arthritis, Systemic Lupus Erythematosus, Sjogren Syndrome, Antiphospholipid Syndrome, and Ankylosing Spondylitis

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