SYSTEMIC LUPUS ERYTEMATOSUS ASSOCIATEDWITH RHEUMATOID ARTHRITIS AND THE IMPORTANCE OF GENETIC FACTORS - CASE REPORT
Abstract:
Systemic lupus erytematosus (SLE) is an autoimmune disease belonging to the collagenosis group. Besides the immune imbalance, there are a series of other factors contributing to its development, like genetic factors, environmental factors, hormonal factors. We are presenting the case of a 48-year old female patient, with a family history of collagenosis, initially diagnosed with rheumatoid arthritis, Raynaud’s syndrome and mixed connective tissue disease, under immunosuppressive therapy with Methotrexate and Prednison. The patient reports after 14 years, the evolving of erythemato-papular lesions, suggestive for lupus, located on photoexposed areas associated with livedo reticularis racermosa, vasospastic crises Raynaud’s type, arthralgia, joint swelling. After clinical and laboratory investigations and biopsy, the SLE diagnosis was confirmed, with the presence of 4 out of 11 ARA diagnosis criteria and mixed connective tissue disease was denied. Anti ds-DNA antibodies positive, anti-Ro antibodies -positive, anti –La - antibodies positive, antiphospholipid antibodies - positive and anti –RNP antibodies were negative. The particularity of the case lies in the presence within the family, of two sisters suffering from major collagenosis (SLE, RA stage IV seropositive and systemic scleroderma with severe pulmonary involvement and Raynaud’s syndrome), fact which advocates for the genetic component of immune imbalance, and for the possible evolution over years of undifferentiated connective tissue disease mixed to SLE, despite immunosuppressive therapy.
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