Rhupus Syndrome Clinical Case and Review of the Literature

Introduction: In 1971 Peter Schur coined the term "Rhupus" for the first time to describe patients who simultaneously had Systemic Lupus Erythematosus (sle) and Rheumatoid Arthritis (ra). Clinical case: A 76-year-old female patient who was admitted due to a one-week history of moderate-intensity frontal headache associated with epistaxis, hematemesis, asthenia, and adynamia. She had a history of rheumatoid arthritis. On physical examination, she was tachycardic, with edema in the wrists, rheumatoid nodule in the elbow, ulnar deviation in the phalanges of both hands, and a swan-neck deformity of the phalanges of both hands. Paraclinical tests showed macrocytic anemia, severe thrombocytopenia, acute kidney injury with microscopic hematuria. Given these findings, it was decided to perform a transfusion of 6 units of platelets and additional studies were carried out, where slightly positive anas was found with positive antidna and non-consumed complement and positive anticcp, so it met the criteria for systemic lupus erythematosus together with rheumatoid arthritis, configuring a Rhupus syndrome, starting management with corticosteroids at intermediate doses, aziatropine and antimalarial, obtaining resolution of the condition. Conclusions: Rhupus Syndrome is a rare overlapping syndrome, where frequency is estimated between 0.01 and 2 % of patients. Paraclinical tests report high sensitivity and usually characterize the presence of anti-cpp, ana, complement consumption, positive rheumatoid factor, C-reactive protein, and anemia. Treatment is based on the addition of disease-modifying antirheumatic drugs, folic acid supplementation, and increased doses of corticosteroids.