DOI: 10.36347/sasjm.2022.v08i09.003

Pages: 597-600

Introduction: Rhupus is the combination of manifestations of RA and SLE, meeting the respective classification criteria of these two pathologies. This uncommon clinical entity with a prevalence of about 0.09% was described by Toone in 1960. Objective: To prove the mutual exclusivity of RA and SLE in rhupus. Observation 1: This was a 40-year-old patient, without children, hypertensive on 10mg of nifedipine, followed for 10 years for RA on 15mg of methotrexate. Admitted for polyarthritis, discoid lupus lesions on the ears, facial erythema in vespertilio, oral ulcers, otherwise, the rest of the physical examination was normal. The biological finds hemolytic anemia (hemoglobin to 9.8g/dl), biological inflammatory syndrome (CRP to 101 mg / l), rheumatoid factors, antinuclear antibodies to 1/564 type speckled appearance, U1RNP, anti-Sm and anti-SSA / Ro 52 were positive and hypocomplementemia CH50 to 21.80 (N : 41-94 U / ml). By the classification criteria the diagnosis of rhupus was retained, 400mg of hydroxychloroquine added to his treatment for 6 months gave a favorable evolution. Observation 2: This was a 21-year-old Guinean student living in Dakar who had been treated for RA for 2 years with 15 mg of methotrexate. She consulted for photosensitivity, erythema in the décolleté and the anterior chest and persistent polyarthritis. Antinuclear antibodies at 1/198 in indirect immunofluorescence on Hep20-10 euroimmun slide, anti-double-stranded DNA antibodies at 640U/ml and anti-Sm at 9U/ml were positive. She received 15mg of methotrexate, 400mg of hydroxychloroquine and 10mg of Prednisolone for 6 months which gave a good improvement. Conclusion: Rhupus seems to be underdiagnosed, its existence is a reality to be understood to face the challenge.