English

Abstract

Rhupus syndrome, overlap of Rheumatoid Arthritis (RA) & Systemic Lupus Erythematosis (SLE), is an extremely uncommon condition. Further involvement of lung (pneumonitis) is rare. We are reporting a case of 28yr old female with multiple joint pain for 10- 12yrs, diagnosed & treated as rheumatoid arthritis for 4 months. She presented with increased severity of joint pain along with high grade fever, chest pain, and decreased appetite. On further investigation, she was found +ve for ANA (Anti-nuclear antibody) & Anti-ds DNA. Her counts were normal, Chest X ray PA showed right lower zone opacity. Repeated sputum examination, & also c/s of sputum revealed no organism (gram +/-ve or AFB). The diagnosis of was confirmed by combined manifestations of RA and SLE & diagnosis of pneumonitis was confirmed on basis of clinical, pathological & radiological evidence. INTRODUCTION: Autoimmune diseases Rheumatoid arthritis (0.5-1.0% of adult population) 1 and SLE (10-400/100,000) 2 are not uncommon and are considered to be separate entity. The coexistence of two or more connective tissue diseases in the same patient is a rare phenomenon, particularly for the coexistence of SLE and RA, which has been estimated between 0.01% and 2%.3,4,5 Joint compromise in systemic lupus erythematosus (SLE) is one of the common manifestations of this disease, with only a small fraction of patients (∼5%) developing deformity in the form of Jaccoud's arthropathy. Less than one percent of patients with SLE develop erosive disease which is indistinguishable from rheumatoid arthritis (RA), an entity known as rhupus. 6 The term rhupus is traditionally used to describe patients with coexistence of rheumatoid arthritis (RA) and systemic