Hassan Ahmed S, Edigin Ehizogie, Patel Axi R, Manadan Augustine
Internal Medicine, HealthLinc East Chicago, Indiana, USA.
Internal Medicine, John H Stroger Jr Hospital of Cook County, Chicago, USA.
Cureus. 2021 Aug 11;13(8):e17103. doi: 10.7759/cureus.17103. eCollection 2021 Aug.
Granulomatosis with polyangiitis (GPA) and rheumatoid arthritis (RA) have shared features including vasculitis, ocular inflammation, interstitial lung disease, and arthritis but existing evidence indicates they are distinct conditions. Interestingly, the co-existence of GPA and RA has been described in the literature. Herein, we report two cases of GPA developing in patients with underlying RA and examine the relationship between the two conditions. Two cases of GPA that developed in patients with preexisting RA are described in detail. Additionally, PubMed was searched for articles in English showing an association of RA and GPA using keywords "rheumatoid arthritis, and vasculitis, and Wegener's, and ANCA, and granulomatosis polyangiitis." In addition to our two cases of RA and GPA overlap, 14 reports were identified in PubMed library from 1970 to 2020. Most of the cases were females (14/16, 88%), and had RA as the initial diagnosis (15/16, 94%). The mean age of RA diagnosis was 45.5 years, the mean age of GPA diagnosis was 52 years and the mean interval between both diagnoses was 101 months. Cyclophosphamide and steroid therapy were used in most of the cases. There are numerous reports of GPA and RA overlap in the literature. GPA should be considered in the differential diagnosis when vasculitis develops in patients with RA.
肉芽肿性多血管炎（GPA）和类风湿关节炎（RA）具有共同特征，包括血管炎、眼部炎症、间质性肺病和关节炎，但现有证据表明它们是不同的疾病。有趣的是，文献中已描述了GPA和RA并存的情况。在此，我们报告两例在患有基础RA的患者中发生的GPA病例，并研究这两种疾病之间的关系。详细描述了两例在已有RA的患者中发生的GPA病例。此外，在PubMed上搜索了使用关键词“类风湿关节炎、血管炎、韦格纳肉芽肿、抗中性粒细胞胞浆抗体、肉芽肿性多血管炎”的英文文章，以查找显示RA与GPA关联的文章。除了我们的两例RA与GPA重叠病例外，在PubMed数据库中还鉴定出1970年至2020年期间的14篇报告。大多数病例为女性（14/16，88%），且最初诊断为RA（15/16，94%）。RA诊断的平均年龄为45.5岁，GPA诊断的平均年龄为52岁，两次诊断之间的平均间隔为101个月。大多数病例使用了环磷酰胺和类固醇治疗。文献中有许多关于GPA与RA重叠的报告。当RA患者发生血管炎时，鉴别诊断中应考虑GPA。
