Pekdiker Mete, Kara Mete
Department of Internal Medicine-Rheumatology, Faculty of Medicine, Mustafa Kemal University, Alahan, Hatay, 31060, Turkey.
Department of Internal Medicine-Rheumatology, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey.
Adv Rheumatol. 2025 Feb 11;65(1):8. doi: 10.1186/s42358-025-00440-z.
There is no consensus on the classification of lupus arthritis (LA). In this study, we aimed to investigate patients with LA who were clinically and serologically very similar to those patients with rheumatoid arthritis (RA).
The electronic medical files of systemic lupus erythematosus (SLE) patients from a single tertiary rheumatology department between 2017 and 2022 were reviewed. The inclusion criteria were being age ≥ 18 years, having nonerosive peripheral arthritis lasting longer than six months, and having dual seropositive (rheumatoid factor (RF) and anti-citrullinated protein antibody (anti-CCP)) serology. A nonerosive course of arthritis was demonstrated by both conventional radiography and joint ultrasound. Images were assessed by two blinded rheumatologists. Patients with drug-induced lupus and those with other rheumatologic diseases were excluded.
The cases of 528 patients were reviewed, and eight patients were included in the study. All patients were female, and the median age was 48.5 years. The median SLE and arthritis durations were 12 and seven years, respectively. The most common SLE symptom was photosensitivity (n = 8). Only one patient had life-threatening involvement (LTI), which was a seizure and autoimmune haemolytic anaemia. All patients had arthritis affecting the wrist and hand. Anti-dsDNA was the most common anti-ENA antibody (n = 7), followed by anti-SSA (n = 5). The median RF and anti-CCP titres were 82.5 IU/ml and 81.5 U/ml, respectively. Five patients had high titres of autoantibodies, and only one patient had slight hypocomplementemia. Three patients needed biologic agents, and remission was achieved after treatment with rituximab.
Despite a long arthritis duration and dual seropositive serology with high titres of RF and anti-CCP, our patients had SLE rather than rhupus syndrome. The low frequency of LTIs, such as lupus nephritis, was a remarkable feature of our patients. Lupus arthritis may be clinically and serologically indistinguishable from RA. Prospective studies are needed to better define LA.
狼疮性关节炎（LA）的分类尚无共识。在本研究中，我们旨在调查临床和血清学上与类风湿关节炎（RA）患者非常相似的LA患者。
回顾了2017年至2022年期间来自单一三级风湿病科的系统性红斑狼疮（SLE）患者的电子病历。纳入标准为年龄≥18岁、非侵蚀性外周关节炎持续时间超过6个月、血清学呈双阳性（类风湿因子（RF）和抗瓜氨酸化蛋白抗体（抗CCP））。传统X线摄影和关节超声均显示关节炎病程无侵蚀性。图像由两名不知情的风湿病学家评估。排除药物性狼疮患者和其他风湿性疾病患者。
共审查了528例患者的病例，8例患者纳入研究。所有患者均为女性，中位年龄为48.5岁。SLE和关节炎的中位病程分别为12年和7年。最常见的SLE症状是光敏性（n = 8）。只有1例患者有危及生命的受累情况（LTI），即癫痫发作和自身免疫性溶血性贫血。所有患者均有关节炎累及手腕和手部。抗双链DNA是最常见的抗可提取核抗原抗体（n = 7），其次是抗SSA（n = 5）。RF和抗CCP的中位滴度分别为82.5 IU/ml和81.5 U/ml。5例患者自身抗体滴度高，只有1例患者有轻微低补体血症。3例患者需要生物制剂，使用利妥昔单抗治疗后病情缓解。
尽管关节炎病程长且血清学呈双阳性，RF和抗CCP滴度高，但我们的患者患有SLE而非rhupus综合征。狼疮性肾炎等LTI的低发生率是我们患者的一个显著特征。狼疮性关节炎在临床和血清学上可能与RA难以区分。需要进行前瞻性研究以更好地定义LA。
