Lupus, “Rhupus” and “Sjrupus”

Abstract

To the Editor: We offer the following comments on the recent article by Baer, et al 1. Overlap of systemic lupus erythematosus (SLE) and Sjögren’s syndrome (Sj) certainly does occur and we are pleased that this has now been recognized and characterized. We wish to add our observations suggesting that this overlap, which we refer to as “sjrupus,” responds well to rituximab. Patient 1. A woman who in 2000 at age 28 years developed autoimmunity characterized by sicca syndrome with positive SSA and SSB antibodies. There were lupus-like skin changes of discoid disease without SLE antibodies. Hydroxychloroquine (HCQ) was efficacious for arthralgia and later leflunomide was somewhat efficacious for lachrymal and salivary disease. In July 2005, coincidental with administration of Depo Provera, she developed severe bulky polysynovitis, lupus rashes on the face, malaise, and fatigue. Anti-dsDNA antibodies were off-scale positive along with SM, rheumatoid factor (RF) in IgA, M and G subclasses, SSA … Address correspondence to Dr. Handler; E-mail: rphandler{at}gmail.com