Overlap syndrome variant: transformation of adults' Still's disease into rheumatoid arthritis (clinical case)

Abstract

Specialists in rheumatology quite often have to deal with the so-called overlap syndromes, characterized by the phenomenon when the onset of the immune-inflammatory process corresponding to one rheumatic disease later turns to another clinical form or even process. It is well known about the possible transformation of rheumatoid arthritis (RA) into systemic scleroderma, Sjögren's disease, systemic lupus erythematosus (SLE). Along with this, of particular interest is the likelihood of developing an autoimmune process in the setting an autoinflammatory syndrome, which includes adult Still's disease (ASD). The article presents a clinical observation demonstrating the transformation of APS into spondyloarthritis, and then into RA. While there are many reports of the transition from systemic juvenile idiopathic arthritis (sJIA) to seropositive RA, the development of seropositive RA in adults with autoinflammatory syndrome is a very rare clinical situation. The analyzed aspect is of particular importance since the approaches to the management of patients with ASD and RA differ significantly in the range of biological agents used in these diseases. So, if the use of IL-1 inhibitors is recommended for the treatment of APS, then with a confirmed diagnosis of RA, the prospect of using other anticytokine agents, preferably IL-6 inhibitors, opens up. Thus, the observed clinical case is interesting not only from the standpoint of the importance of the precise form of the immune mediated disease identification at the time of choosing the optimal treatment, but also the differentiated use of biological agents, including Russian-made IL-6 inhibitors.