Discussion:
Psoriasis is a chronic autoimmune skin condition that leads to rapid
skin cell production, resulting in scaling and inflammation, and is
often linked with other autoimmune diseases, including RA and
SLE5. In patients with rhupus, psoriasis can
exacerbate the complexity of treatment, as both RA and SLE may influence
the severity and presentation of skin lesions. Moreover, psoriasis can
also lead to psoriatic arthritis (PsA), an inflammatory arthritis
affecting some individuals with psoriasis, further complicating the
clinical picture6. Managing rhupus with psoriasis
requires a careful and tailored approach, considering the overlapping
symptoms and potential for multi-organ involvement, as seen in patients
with systemic vasculitis7.
The pathophysiology of Rhupus syndrome involves immune-mediated
mechanisms characteristic of both RA and SLE, including the production
of autoantibodies and systemic inflammation. Anti-cyclic citrullinated
peptide (Anti-CCP) and rheumatoid factor (RF) are biomarkers commonly
used in diagnosing RA. At the same time, antinuclear antibodies (ANA)
and anti-double stranded DNA (anti-dsDNA) are hallmark features of SLE.
However, in Rhupus, these markers often overlap, making it difficult to
distinguish between RA and SLE early in the disease
process8.
This case was initially underscored due to psoriasis, which neglected
the need to evaluate other causes of arthritis further. But eventually,
thorough examination & lab workup lead to the correct etiology of
arthritis. Since DMARD “Apremilast” didn’t show any response, it came
to our suspicion that something else pathophysiology must work in this
patient. Overlapping features of rheumatoid arthritis and SLE and some
non-specific systematic findings made this case more complex. Rhupus is
a rare disease with no established criteria or guidelines to treat. We
want to notify this case to warrant more attention from policymakers and
clinicians to get insights to implement this future research.
Our current literature notifies that treatment typically involves a
combination of medications and lifestyle changes to manage symptoms and
improve quality of life. However, the exact etiology and triggers of
rhupus remain unknown, with genetic, immunological, hormonal, and
environmental factors potentially playing a role9,10.
Author Contribution:Asif Amin: Conceptualization, Data curation, Writing – review
and editingZahin Shahriar: Methodology, Formal analysis, Writing –
original draftMinhajul Hossain: Project administration, SupervisionRahatul Ishakh: Investigation, SoftwareShah Tanvir: Validation, Resources, Visualization