Presence of antibodies against cyclic citrullinated peptides in patients with 'rhupus': a cross-sectional study

Amezcua-Guerra, Luís M.; Springall, Rashidi; Márquez-Velasco, Ricardo; Gómez-García, Lorena; Vargas, Angélica; Bojalil, Rafael

doi:10.1186/ar2036

Cited by 74 publications

(20 citation statements)

References 17 publications

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“…The term “Rhupus syndrome” is used to describe the coexistence of SLE and RA, wherein patients have symmetrical erosive arthritis and characteristic manifestations of SLE. 7 The definition of Rhupus syndrome remains controversial, as the immunopathological process of SLE is considered to be the exact opposite of RA. Abnormal activation of T helper type 2 cell (Th2) cytokines plays a central role in SLE while T helper type 1 cells (Th1) participate in RA.…”

Section: Discussionmentioning

confidence: 99%

“… 12 Some rheumatologists have classified Rhupus syndrome as a subset of SLE with severe arthritis. 7 , 12 SLE shows three types of articular involvement: intermittent nonerosive polyarthritis usually found in the hands, wrists, and knees; nonerosive deforming arthritis referred to as Jaccoud’s joint; and arthritis with joint deformities and specific erosion, that is, Rhupus syndrome. 13 Most patients with SLE have transient, migratory, and reversible arthritis without erosion.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Analysis of 56 Patients with Rhupus Syndrome

Huang

et al. 2014

Medicine

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To investigate the clinical features of Rhupus syndrome, we retrospectively reviewed the medical records of 56 patients with Rhupus who were hospitalized at the Peking Union Medical College Hospital, Beijing, China, between January 2000 and March 2013. We analyzed the clinical manifestations of Rhupus syndrome and compared these with a control group of 160 randomly selected systemic lupus erythematosus (SLE) patients without coexisting rheumatoid arthritis (RA). In our center, 1.30% (56/4301) of hospitalized SLE patients had Rhupus syndrome. The median disease duration was 8.0 years and 83.9% had RA onset. All Rhupus patients showed radiological erosion in the joints. Compared with the control group, Rhupus patients had a longer disease duration, higher prevalence of anticyclic citrullinated peptide antibody and rheumatoid factor, higher incidence of symmetrical polyarthritis with more joint deformities and rheumatic nodules, and increased erythrocyte sediment rate and c-reactive protein levels (P < 0.005). In addition, a lower SLE disease activity index and incidences of malar rash, hemolytic anemia, renal and neurological involvement (P < 0.005), and hypocomplementemia (P < 0.05) was observed in the Rhupus group.Rhupus syndrome is rare in SLE patients. Most Rhupus patients had RA onset and a distinctive clinical profile characterized by more severe RA-associated and mild SLE-associated damage. Specific autoantibodies and imaging findings could be helpful for making accurate Rhupus diagnoses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Analysis of 56 Patients with Rhupus Syndrome

Huang

et al. 2014

Medicine

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“…There are three viewpoints on RHUPUS. Some authors such as Fernandez believe that RHUPUS arthropathy is a serious articular involvement of lupus and it is different from a superposition or overlap of RA and SLE [16, 17], while other authors believe that RHUPUS syndrome is combination of SLE and chronic erosive polyarthritis [5, 9, 15], and the last group believes that RHUPUS is overlap of RA or JIA and SLE (regardless to poly or oligoarthritis and erosive or nonerosive) [4, 18]. We agree with last group about RHUPUS syndrome in children.…”

Section: Discussionmentioning

confidence: 99%

“…In our case report, one case had erosive arthritis before completing JSLE, and in our litrature review, just 45% cases had joint erosion (Table 1). Recently, Amezcua-Guerra studied the prevalence of antibodies against anti-CCP antibodies in RHUPUS [18], and they concluded that RHUPUS is an overlap between RA and SLE. …”

Section: Discussionmentioning

confidence: 99%

RHUPUS Syndrome in Children: A Case Series and Literature Review

Ziaee

Moradinejad

Bayat

2013

Case Reports in Rheumatology

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Objective. Overlap of juvenile idiopathic arthritis (JIA) and juvenile systemic lupus erythematosus (JSLE) is a rare clinical condition in children. This condition has been described as RHUPUS syndrome. Prevalence of this syndrome and 3 cases are reported in this paper. Cases Presentation. During 10 years, 3 patients with SLE had chronic arthritis before or after diagnosis of SLE. Prevalence of this disorder in JSLE was 2.5%. Two patients were females and one of them was a male. According to our review, mean delay between chronic joint involvement and JSLE diagnosis was 50.1 months. In our case report, two females had joint erosion and one of them died due to heart failure, but in the literature review, just 45% cases had joint erosion and 70% cases were polyarticulare form. Conclusion. RHUPUS is unusual presentation of lupus in children. It seems that clinical feature and outcome of RHUPUS syndrome are different in children due to difference between RA and JIA. We suggest juvenile RHUPUS for overlap of JIA and JSLE.

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“…For example, in systemic lupus, ACPA positivity is associated with “rhupus” in which the signs and symptoms of RA prevail. 13 , 14 …”

Section: Introductionmentioning

confidence: 99%

In Antisynthetase Syndrome, ACPA Are Associated With Severe and Erosive Arthritis

et al. 2015

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Anticitrullinated peptide/protein antibodies (ACPA), which are highly specific for rheumatoid arthritis (RA), may be found in some patients with other systemic autoimmune diseases. The clinical significance of ACPA in patients with antisynthetase syndrome (ASS), a systemic disease characterized by the association of myositis, interstitial lung disease, polyarthralgia, and/or polyarthritis, has not yet been evaluated with regard to phenotype, prognosis, and response to treatment. ACPA-positive ASS patients were first identified among a French multicenter registry of patients with ASS. Additionally, all French rheumatology and internal medicine practitioners registered on the Club Rhumatismes et Inflammation web site were asked to report their observations of ASS patients with ACPA. The 17 collected patients were retrospectively studied using a standardized questionnaire and compared with 34 unselected ACPA-negative ASS patients in a case–control study. All ACPA-positive ASS patients suffered from arthritis versus 41% in the control group (P < 0.0001). The number of swollen joints was significantly higher (7.0 ± 5.0 vs 2.9 ± 3.9, P < 0.005), with a distribution resembling that of RA. Radiographic damages were also more frequent in ACPA-positive ASS patients (87% vs 11%, P < 0.0001). Aside from a significantly higher transfer factor for carbon monoxide in ACPA–ASS patients, lung, muscle, and skin involvements had similar incidences, patterns, and severity in both groups. Although Nonbiologic treatments were similarly used in both groups, ACPA-positive patients received biologics more frequently (59% vs 12%, P < 0.0008), mostly due to refractory arthritis (n = 9). Eight patients received anti-Cluster of differentiation 20 (CD20) monoclonal antibodies (mAbs) with good efficacy and tolerance, whereas 2 of the 5 patients treated with antitumor necrosis factor drugs had worsened myositis and/or interstitial lung disease. After a >7-year mean follow-up, extra-articular outcomes and survival were not different. ACPA-positive ASS patients showed an overlapping RA–ASS syndrome, were at high risk of refractory erosive arthritis, and might experience ASS flare when treated with antitumor necrosis factor drugs. In contrast, other biologics such as anti-CD20 mAb were effective in this context, without worsening systemic involvements.

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Presence of antibodies against cyclic citrullinated peptides in patients with 'rhupus': a cross-sectional study

Cited by 74 publications

References 17 publications

Clinical Analysis of 56 Patients with Rhupus Syndrome

Clinical Analysis of 56 Patients with Rhupus Syndrome

RHUPUS Syndrome in Children: A Case Series and Literature Review

In Antisynthetase Syndrome, ACPA Are Associated With Severe and Erosive Arthritis

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