269 Coexistence of axial spondyloarthritis, systemic lupus erythematosus, sjögrens syndrome and secondary antiphospholipid syndrome: case report Tarhan F*, Keser G, Çelik Ö*, Klnç RM*, Akar S

Abstract

Background Axial spondyloarthritis (AxSpA) is a chronic inflammatory disease of the axial skeleton which manifests as inflammatory back pain and progressive stiffness of the spine. Patients with axial disease and other features of SpA but no unequivocal sacroiliitis in conventional X-ray now termed as non-radiographic axial spondyloarthritis (nr-AxSpA). Those patients can be diagnosed on the basis of the presence of active inflammation in magnetic resonance imaging (MRI) or human leukocyte antigen B27 (HLA-B27).Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown etiology that may affect the skin, joints, kidneys, lungs, nervous system, sereous membranes, and/or other organs of the body. Sjogrens syndrome (SS) is the second most common autoimmune rheumatic condition characterized by lymphocytic infiltrate of the exocrine glands, resulting in dysfunction and destruction of them. Antiphospholipid syndrome (APS) is the association of thrombosis and/or pregnancy morbidity with antiphospholipid antibodies (aPL) (lupus anticoagulant [LA], anticardiolipin antibodies (aCL), and/or anti-2 -glycoprotein-I antibodies (a2 GPI). Methods Case Presentation We report a 55-year-old female patient having the association of nr-AxSpA, SLE, secondary APS, and SjS. Diagnosis of nr-AxSpA was made based upon the presence inflammatory low-back pain, human leukocyte antigen B27 positivity, and presence of sacroiliitis only in MRI. SLE was diagnosed with butterfly-shaped rash on her cheeks, inflammatory arthritis, photosensitivity, erythema involving dorsal inter-joint area of hand fingers, alopecia together with antinuclear antibody (ANA) and anti-dsDNA positivity, low serum complement levels, leucopenia and thrombocytopenia. Additional presence of sicca symptoms, low Schirmer I test, anti SSA/Ro and anti-SSB/La positivity, supported by positive labial salivary gland biopsy led to the diagnosis of SjS. Results Furthermore, this patient also had miscarriage at 16th week and cerebral vascular disease at 33 years. Besides, IgG and IgM anticardiolipin antibodies were found to be positive twice. Therefore, she was also diagnosed as secondary APS. She fulfilled the relevant criteria for AxSpA, SLE, SjS and APS. Conclusions To our knowledge, this is the first case report showing the association of these four diseases, with different genetic, etiopathogenetic and clinical systemic inflammatory diseases. Funding Source(s): No