Rhupus: Illustration about four Senegalese Cases

Introduction Rhupus is a combination of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). It is a rare entity whose existence is often controversial. Since its first description in 1971 by Schur, fewer than 150 cases have been described in the literature. We are reporting four observations. Materials and methods A retrospective study, carried out between August 2011 and March 2014 in the Department of Internal Medicine at the University Hospital Aristide Le Dantec, was used to collect the observations of patients with rhupus. The diagnosis of RA and SLE was based on epidemiological, clinical and paraclinical arguments in accordance with the ACR / EULAR 2010 criteria for PR and ACR 1997 for SLE. Observations Four observations were collected in 2 women and 2 men of average age 33 years (extremes 28 years and 36 years). They all had chronic polyarthritis (1 to 10 years of evolution), polysynovial, and peripheral with irreducible deformations in 3 patients with ulnar stroke type, ankylosis of the wrists and buttonhole. The extra-articular manifestations were rheumatoid nodules (1 case) and an erythema malar in vespertilio and decollete (1 case). A non-specific biological inflammatory syndrome was present in all patients. Two patients had lymphopenia at 1176 and 1220 / mm3. On the immunological level, there was a positivity of rheumatoid factors (1 case), anti-nuclear (1 case with speckled fluorescence), anti-CCP antibodies (3 cases), anti-RNP antibodies (3 cases) Anti-SmRNP (3 cases), and anti-Sm (3 cases), anti-SSA / Ro and SSB / La (1 case). The standard X-ray showed a demineralization of the bones of the carpus and epiphyseal in bands (1 case), a radio carpal pinching (2 cases) and proximal interphalangeal (2 cases), a carpite (3 cases), an erosion of the head of proximal phalanges and metacarpals (3 cases). Radiography of the hands and feet was normal in one patient. A therapeutic management combined low-dose of corticosteroids (4 cases), hydroxychloroquine (4 cases) and methotrexate (3 cases). The progression was favorable in 2 patients, one had persistent monoarthritis moderately responding to infiltration and one patient was lost from view. Conclusion Although rarely reported in the literature, the association of rheumatoid arthritis and lupus remains a reality. Thus, in the face of any systemic pathology, attention must be paid to the other associated autoimmune diseases.