Concomitant systemic lupus erythematosus and ankylosing spondylitis.

The case is reported of a 42 year old white woman meeting currently used diagnostic criteria for both ankylosing spondylitis and systemic lupus erythematosus (SLE). As found in a previously described similar case of a black man, HLA typing showed antigens associated with both SLE and seronegative spondyloarthropathy. This case thus supports the hypothesis that the two diseases occur together only when this rare combination of HLA antigens is present.     

Health-related quality of life and utility: comparison of ankylosing spondylitis,rheumatoid arthritis,and systemic lupus erythematosus patients in Taiwan

The purpose of this study was to evaluate the health-related quality of life among patients with ankylosing spondylitis (AS), rheumatoid arthritis (RA), or systemic lupus erythematosus (SLE). This prospective, cross-sectional survey was conducted from September 1, 2008 to August 31, 2009. Patients answered questions with regard to demographics and disease characteristics and also completed generic (SF-36) and preference-based utility (SF-6D and EQ-5D) instruments. Multivariate analysis assessed the relationship of RA and SLE to AS with respect to the outcomes of the different health-related quality of life instruments. In general, baseline and disease characteristics differed across the three disease groups. Compared to SLE patients, RA patients scored worse on the higher-order summary scores of physical (PCS) and mental components (MCS) of SF-36 (P ≤ 0.002) and total SF-36 (P ≤ 0.005). RA also had worse PCS than AS (P ≤ 0.001). SLE patients scored higher on the utility score of SF-6D compared with RA patients and higher than both AS and RA patients for the utility score of EQ-5D. Multivariate analysis found that compared with AS patients, RA had significantly lower SF-36 total score and PCS, and SLE patients had greater PCS and a greater EQ-5D utility score. Multivariate analysis found no difference across the patient groups with respect to MCS or SF-6D utility score. These findings suggest that among the three rheumatic diseases studied, RA patients have the worse health-related quality of life, and AS patients have similar or poorer health-related quality of life as SLE patient.     

Quantification of radiological damage in inflammatory arthritis: rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis

Quantification of radiological damage in inflammatory arthritis is important. It has proven its value in clinical trials, but its use in clinical practice is becoming more important as well. Scoring methods for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis are available. These differ in the joints and features assessed. This results in differences in the scoring range, but also in the method of performance. The various methods for the three diseases are detailed in this chapter. Most information is available for rheumatoid and for this disease the relationship between radiological damage and long-term outcome is summarised.     

Drug-induced systemic lupus erythematosus in ankylosing spondylitis associated with infliximab

SIR, Infliximab therapy for the treatment of rheumatoid arthritisand Crohn disease has been associated with the development ofpolyarthritis, fever, induction of autoantibodies [antinuclearantibodies (ANA) and anti-double-stranded DNA (ds-DNA)] anddermatological events that are all compatible with systemiclupus erythematosus (SLE) [1, 2]. These symptoms have been attributedto the increasing levels of ANA induced during therapy withanti-tumour necrosis factor [3]. The induction of autoantibodiesin     

Cricoarytenoid arthritis with rheumatoid arthritis and systemic lupus erythematosus

A 56-year-old woman with rheumatoid arthritis (RA) suddenly developed severe respiratory distress and laryngeal stridor, which required endotracheal intubation. She had had RA for 12 years, which had been controlled well with prednisolone (3 mg/day) at the orthopedic clinic. Laryngoscopy revealed cricoarytenoid arthritis. She was finally diagnosed as having overlap syndrome with RA and systemic lupus erythematosus. She was given high dose corticosteroids that improved her clinical symptoms and laryngoscopic findings. She represents the first patient with overlap syndrome who developed an acute airway obstruction due to cricoarytenoid arthritis.     

Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis

OBJECTIVE: To compare the prevalence of cardiovascular diseases and their risk factors between patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) and control subjects. METHODS: Data for patients continuously enrolled in an integrated outcomes database between January 1, 2001, and December 31, 2002, with International Classification of Diseases, 9th Revision codes of 714.x (RA), 696.0 (PsA), or 720.0 (AS) were evaluated in this cross-sectional comparative study. Control groups were established for each patient group (1:4 ratio) by matching on the basis of age, sex, geographic region, and length of time in plan. Age- and sex-adjusted prevalence of cardiovascular comorbidities and risk factors were calculated; the prevalence ratio of the comorbidities and risk factors for the patient groups compared with the control population were estimated. Use of selected cardiovascular medications was also compared between patient and control groups. RESULTS: The RA, PsA, and AS cohorts comprised 28,208, 3066, and 1843 patients, respectively. The prevalence ratio of ischemic heart disease (1.5, 1.3, 1.2), atherosclerosis (1.9, 1.4, 1.5), peripheral vascular disease (2.4, 1.6, 1.6), congestive heart failure (2.0, 1.5, 1.8), cerebrovascular disease (1.6, 1.3, 1.7), type II diabetes (1.4, 1.5, 1.2), hyperlipidemia (1.2, 1.2, 1.2), and hypertension (1.3, 1.3, 1.3) were higher in patients than controls. For RA, PsA, and AS, use of angiotensin-converting enzyme inhibitors, calcium channel blockers, diuretics, nitrates/vasodilators, anticoagulants, and antihyperlipidemia agents was significantly higher in patients than controls. CONCLUSION: Cardiovascular diseases and their risk factors were more common in patients with RA, PsA, and AS than in matched controls.     

Antibody-mediated lymphocytotoxicity in rheumatoid arthritis and systemic lupus erythematosus

Lymphocyte-dependent antibody cytotoxicity (LDAC) was studied using peripheral blood and in some instances synovial fluid cells from patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). No difference from normal controls was observed with peripheral blood lymphocytes from either RA or SLE. Marked decrement in LDAC effector cell activity was present particularly with RA synovial fluid cells. Sera from patients with RA or SLE as well as RA synovial fluids markedly inhibited LDAC.     

Lymphokine production in rheumatoid arthritis and systemic lupus erythematosus

The production of interferon (IFN) by peripheral blood lymphocytes from patients with rheumatoid arthritis (RA) and of IFN and interleukin 2 (IL-2) in systemic lupus erythematosus (SLE) was compared with that of healthy controls. Patients with SLE showed a significant reduction in IL-2 production compared to controls if the PBL were irradiated before mitogen stimulation. No patient with RA or SLE studied had impaired IFN production regardless of disease activity and the IFN produced was always IFN-gamma in type. We conclude that there is an abnormality in IL-2 production in SLE but there is no abnormality in IFN-gamma production in either RA or SLE.     

Thyroid disease in systemic lupus erythematosus and rheumatoid arthritis

SIR, We determined the degree of overlap between autoimmunethyroid disease and two non-organ-specific autoimmune diseases,systemic lupus erythematosus (SLE) and rheumatoid arthritis(RA). Both SLE and RA are commonly encountered in our out-patientpractice and were chosen because of their clinical relevance. Sixty-nine SLE and 64 RA patients fulfilling the American RheumatismAssociation criteria for SLE [1] and RA [2] were selected forthis study. Patients from both groups were found     

Infections in systemic lupus erythematosus and rheumatoid arthritis.

Patients with systemic lupus erythematosus have a higher infection rate than the general population. It is estimated that at least 50% of them will suffer a severe infectious episode during the course of the disease. Improvements in the control of the disease are discussed in this article.     

The coexistence of rheumatoid arthritis and systemic lupus erythematosus

Summary A 29-year-old white female with longstanding classical rheumatoid arthritis (RA) developed clinical and serological manifestations of systemic lupus erythematosus (SLE) with prominent signs of diffuse proliferative lupus nephritis. She fulfilled the ARA criteria for the classification of SLE as well as the ARA criteria for classical RA. The concomitant presence of these two affections in the same patient is rare and the discriminating features suggest that this coexistence may be coincidental. With respect to treatment, our patient had good relief of symptoms by a combined administration of methylprednisolone pulses and cyclophosphamide.     

Anemia,serum vitamin B12, and folic acid in patients with rheumatoid arthritis,psoriatic arthritis,and systemic lupus erythematosus

OBJECTIVE:Although anemia is frequent in inflammatory rheumatic diseases, data regarding vitamin B12 status is scarce. The purpose of this study was to analyze the incidence and nature of B12 and folic acid (FA) deficiencies in a cohort of rheumatic patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and systemic lupus erythematosus (SLE). METHODS: Levels of B12, FA, and parameters of anemia were recovered or examined in 276 outpatients. In those with recent findings of low serum B12 levels, further studies of serum homocysteine (Hcy) and urine methylmalonic acid (MMA) levels were performed. RESULTS: The incidence of anemia was high: 49%, 46%, and 35%, in RA, SLE, and PsA, respectively. Low levels of serum B12 were also frequent (24%), with almost similar occurrence in the three disease groups. Deficiency in FA was rare (<5%). Mean levels of both vitamins did not differ significantly among the three groups. No correlation between serum B12 levels and anemia was found. In the 15 patients with recently detected low B12 levels, Hcy and MMA were evaluated before and following B12 therapy. In ten of them, baseline Hcy levels were high, while MMA was increased in one patient only. Response to B12 administration, i.e., a decrease in Hcy and/or MMA levels, was noticed in four patients only, suggesting that only 26% of the low-serum-B12 patients had true B12 deficiency. CONCLUSIONS: The incidences of anemia and decreased serum B12 levels were high in these three groups of rheumatic patients. However, true tissue deficiency seems to be much rarer.     

The eye and inflammatory rheumatic diseases: The eye and rheumatoid arthritis,ankylosing spondylitis,psoriatic arthritis

Rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis are associated with potentially sight-threatening inflammatory eye disease. Although the ocular manifestations associated with ankylosing spondylitis and psoriatic arthritis are similar, such as anterior uveitis, this differs from rheumatoid arthritis where dry eye, peripheral ulcerative keratitis and scleritis are the major ocular complications. Apart from causing sight loss, these conditions are painful, debilitating, often recurrent or chronic and may require long-term therapy. Treatments such as ocular lubricant, topical corticosteroid, systemic corticosteroid and systemic immunosuppression are often similar for the underlying systemic disease. Yet for the treatment of the ocular complications, the evidence base is weak. Close collaboration with a rheumatologist is often essential, particularly in the management of these patients.     

Coexisting rheumatoid arthritis and ankylosing spondylitis

Since the second publication by some of the present authors in which 10 patients with coexisting rheumatoid arthritis (RA) and ankylosing spondylitis (AS) were described, 7 new cases have been found. For accuracy, all cases of the original study still available were reexamined. Of the total of 17 cases, 13 were male and 4 female. All had positive tests for rheumatoid factor and 6 had subcutaneous nodules. The male predominance and the frequency of nodules are consistent with other publications. In addition, our study demonstrates the strong association of each of these 2 diseases with its genetic marker: the antigen HLA-DR4 was present in 8 of 12 cases tested and the antigen HLA-B27 was present in 16 of the 17 cases. The coexistence of these 2 classical rheumatological entities in the same patient appears to occur by chance and is probably often overlooked.     

Frequency of neoplasia in systemic lupus erythematosus and rheumatoid arthritis

A patient population admitted to the hospital for either SLE or RA was surveyed for the subsequent development of neoplasms. The frequency of neoplasm in SLE patients appeared to be exaggerated, whereas the frequency of subsequent neoplasm in rheumatoid patients was unexpectedly low. A paucity of nephritis in the SLE group was noted. Further reports are encouraged so that the magnitude of the risk of malignancy developing with immunosuppressive therapy can be more precisely ascertained.