Introduction: Joint involvement is common in systemic lupus erythematosus (SLE) patients, however, screening for joint specific autoantibodies in patients is not routinely performed. This may be due to the lack of known antigens and available tissue. The rat musculoskeletal tissue may be a suitable source of antigen to detect arthritic autoantibodies. Method: We tested plasma of SLE patients, with arthritis (N=9) and without arthritis (N=7) as well as plasma from normal individuals (N=7) on fresh sectioned tissue from rat plantar hind paw using indirect immunofluorescence method. Results: Binding of autoantibodies to striation in skeletal muscle cells in the tissue was clearly demonstrable in all samples from SLE with arthritis but not on slides incubated with plasma from normal or SLE without arthritis. Conclusion: Thus, rat plantar tissue may be suitable for detecting autoantibodies from SLE patients that may be involved in the pathogenesis of lupus arthritis.
Lupus arthritis

Overlap syndrome is used to describe patients who have two or more well-defined connective tissue diseases. Although a variety of overlap syndromes are now recognized, the coexistence of the progression of juvenile rheumatoid arthritis (JRA) to systemic lupus erythematosus (SLE) is uncommon. We describe a patient who had typical deforming polyarthritis, who years later developed SLE.
Arthritis ; Arthritis, Juvenile* ; Connective Tissue Diseases ; Humans ; Lupus Erythematosus, Systemic*

The clinical manifestations and immunohistologic findings of drug-induced lupus erythematosus (DILE) are similar to those of idiopathic lupus. However, DILE is different from idiopathic lupus because it is induced after continuous drug exposure and resolves after discontinuation of the causative drug. DILE can be divided into systemic lupus erythematosus, subacute cutaneous lupus erythematosus, and chronic cutaneous lupus erythematosus (CCLE). Lupus erythematosus profundus is a subtype of CCLE, and drug-induced CCLE is very rarely reported in the literature. Herein, we report a rare case of adalimumab-induced lupus erythematosus profundus developed in a rheumatoid arthritis patient. The patient is a 43-year-old Korean woman who had multiple tender nodules and plaques on her face, trunk, and both extremities after using adalimumab for rheumatoid arthritis. She was diagnosed with adalimumab-induced lupus erythematosus profundus, and her condition improved after discontinuation of adalimumab.
Adult ; Arthritis, Rheumatoid* ; Extremities ; Female ; Humans ; Lupus Erythematosus, Cutaneous ; Lupus Erythematosus, Systemic ; Panniculitis, Lupus Erythematosus* ; Adalimumab

The clinical manifestations and immunohistologic findings of drug-induced lupus erythematosus (DILE) are similar to those of idiopathic lupus. However, DILE is different from idiopathic lupus because it is induced after continuous drug exposure and resolves after discontinuation of the causative drug. DILE can be divided into systemic lupus erythematosus, subacute cutaneous lupus erythematosus, and chronic cutaneous lupus erythematosus (CCLE). Lupus erythematosus profundus is a subtype of CCLE, and drug-induced CCLE is very rarely reported in the literature. Herein, we report a rare case of adalimumab-induced lupus erythematosus profundus developed in a rheumatoid arthritis patient. The patient is a 43-year-old Korean woman who had multiple tender nodules and plaques on her face, trunk, and both extremities after using adalimumab for rheumatoid arthritis. She was diagnosed with adalimumab-induced lupus erythematosus profundus, and her condition improved after discontinuation of adalimumab.
Adult ; Arthritis, Rheumatoid* ; Extremities ; Female ; Humans ; Lupus Erythematosus, Cutaneous ; Lupus Erythematosus, Systemic ; Panniculitis, Lupus Erythematosus* ; Adalimumab

No abstract available.
Arthritis, Rheumatoid ; Humans ; Influenza, Human ; Lupus Erythematosus, Systemic ; Vaccination

OBJECTIVE: To investigate the types and distribution of musculoskeletal ultrasonographic changes of the symptomatic joints, their correlations with clinical manifestations in systemic lupus erythematosus (SLE) patients, as well as the differences of ultrasonographic changes from Rhupus syndrome [SLE overlapping with rheumatoid arthritis (RA)] patients. METHODS: In the study, 114 SLE patients who complained of arthralgia or arthritis from May 2014 to August 2017 and 15 Rhupus syndrome patients were recruited for ultrasound evaluation. Ultrasound scans of the symptomatic joint areas were completed. The correlation between ultrasonographic changes and clinical characteristics was analyzed. Additionally, ultrasound changes of bilateral wrists and hands of the SLE patients were compared with those of the Rhupus syndrome patients. RESULTS: In a total of the 114 SLE patients with 1 866 joints scanned, synovial hyperplasia, tenosynovitis, erosion, and osteophytes were all observed. Synovial hyperplasia was more often observed in wrists in 33.3% (23/69) patients, knees in 28.6% (12/42) patients, and ankles in 25.0% (7/28) patients. Tenosynovitis and erosion were most commonly found in shoulders in 35.0% (7/20) and 65.0% (13/20) patients. Osteophytes were more common in proximal interphalangeal (PIP) joints, elbows and knees. Among 69 patients with 22 joints (bilateral wrists and hands) scanned, 57 (82.6%) of them had ultrasonographic changes. Synovial hyperplasia was observed in 36.2% of the patients and erosion in 14.5% of the patients. The agreement between synovial hyperplasia and swollen joints in PIP was fair (κ=0.633, P<0.01), however poor in wrists between synovial hyperplasia and swollen/tender joints (κ=0.089, P=0.584). 18.4% patients with synovial hyperplasia had no tenderness or swollen clinically, while 15.8% patients with tenderness or swollen had no synovial hyperplasia on ultrasound. No correlation was found between ultrasonographic changes with the SLE disease activity index. Both synovial hyperplasia and erosion were more common in the Rhupus syndrome patients (73.3% vs. 36.2%, P=0.08; 66.7% vs. 14.5%, P=0.03) with significantly higher grey scale scores (7.4±6.4 vs. 1.6±4.1, P=0.04) than in the SLE patients. CONCLUSION Variety of changes could be observed by ultrasound in different joint areas of SLE patients. The ultrasonographic changes and clinical manifestations did not always correspond to each other. Synovial hyperplasia and erosion was more common in Rhupus syndrome patients.
Arthralgia ; Arthritis, Rheumatoid ; Humans ; Lupus Erythematosus, Systemic ; Ultrasonography

Vitiligo is a multifactorial disorder. Neural, biochemical, and autoimmune mechanisms have been hypothetically suggested as etiopathological contributors to this condition. Autoimmunity focuses primarily on genetic factors and the association between vitiligo and other autoimmune disorders including autoimmune thyroid disease, rheumatoid arthritis, psoriasis, type 1 diabetes, pernicious anemia, and Addison's disease. We describe a 35-year-old man with systemic lupus erythematosus who developed concurrent vitiligo and discoid lupus erythematosus suggesting the possible autoimmune association between these 2 different diseases.
Addison Disease ; Adult ; Anemia, Pernicious ; Arthritis, Rheumatoid ; Autoimmunity ; Humans ; Lupus Erythematosus, Discoid ; Lupus Erythematosus, Systemic* ; Psoriasis ; Thyroid Diseases ; Vitiligo*

OBJECTIVE: This study was designed to evaluate clinical features of 20 patients with rhupus syndrome and compare its characteristics with systemic lupus erythematosus(SLE) and rheumatoid artiritis(RA). METHODS: Patients considered to have rhupus who met the American College of Rheumatology(ACR) 1997 and 1987 revised criteria for SLE and RA, respectively and age, sex, and disease duration matched 64 patients with RA and 56 patients with SLE were selected for comparison. RESULTS: Twenty patients were all female and their mean age was 43.7+/-9.6 years(range 25~68). They had 5.5 ACR criteria for RA and 5 criteria for SLE. The mean age at onset of RA was 35.2+/-10.5 years(19~63) and that of SLE was 38.2+/-10.0 years(20~63), giving a mean interval between the diagnoses of the two diseases of 3.0+/-5.7 years (14~(-6)). There were 2 patients(10%) with rheumatoid nodule, and 18 patients(90%) with rheumatoid factor, and 16 patients(80%) with bone erosions on hand or wrist joints. The criterial for SLE included malar rash(20%), discoid rash(0%), photosensitivity(30%), oral ulcer(45%), arthritis(100%), serositis(35%), renal disorder(15%), neurologic disorder(0%), hematologic disorder(100%), immunologic disorder(90%), and positive antinuclear antibody(100%). Anti-dsDNA was more than 7.0U/ml in 15 patients(75%). The patients with rhupus syndrome showed lower amount of 24 hour urine protein, more severe radiologic involvement, younger age at onset of arthritis, higher titer of rheumatoid factor, lower frequency of low C3, and less complicated clinical course when compared with the patients with SLE(p<0.05). More frequent anemia, Rayanud's phenomenon, and more complicated clinical course in rhupus when compared with the patientw with RA(p<0.05), but the radiologic stage of hand and wrist was similar between rhupus and RA. CONCLUSION: Rupus syndrome showed somethisg different clinical characteristics and clinical course when compared with SLE and RA.
Anemia ; Arthritis ; Arthritis, Rheumatoid* ; Diagnosis ; Female ; Hand ; Humans ; Lupus Erythematosus, Systemic* ; Rheumatoid Factor ; Rheumatoid Nodule ; Wrist ; Wrist Joint

Approximately 90% of nontuberculous mycobacterium (NTM) infections involve the pulmonary system; NTM infections involving areas of the musculoskeletal system such as the joints or spine are uncommon. This report describes a case of refractory knee swelling in a patient with systemic lupus erythematosus (SLE). Indolent arthritis of the knee eventually progressed to spondylitis and a paraspinal abscess requiring surgical incision and drainage. The cause of the infectious arthritis and spondylitis was diagnosed as NTM infection, specifically Mycobacterium kansasii. This case emphasizes the importance of a high index of clinical suspicion for mycobacterial infection, as well as repeated attempts to isolate the organism, in patients with SLE who present with atypical chronic arthritis.
Abscess ; Arthritis* ; Arthritis, Infectious ; Drainage ; Humans ; Joints ; Knee ; Lupus Erythematosus, Systemic ; Musculoskeletal System ; Mycobacterium kansasii ; Nontuberculous Mycobacteria* ; Spine ; Spondylitis*

The relationship between thyroid disease and rheumatic disorders has been the subject of considerable debate. Autoimmune thyroid disease (ATD), such as Graves' disease, Hashimoto's thyroiditis are occasionally associated with systemic lupus erythematosus, Sj gren syndrome, and rheumatoid arthritis (RA). Although the exact mechanism of this association is not well documented, genetic factor, immunologic defect, hormonal factor, drugs for treatment might contribute for it. There is a question of whether common factors are involved in the etiology of RA and thyroid disease, and controversy over whether an association between RA and ATD exists. The possibility of coexistent thyroid disease in patients with RA should be carefully considered throughout the course of follow-up. Recently, we experienced a 39-year-old male patient with RA during treatment of Graves' disease, and present the case here with brief review of literatures.
Adult ; Arthritis ; Arthritis, Rheumatoid* ; Autoimmunity ; Follow-Up Studies ; Graves Disease* ; Humans ; Lupus Erythematosus, Systemic ; Male ; Thyroid Diseases ; Thyroid Gland ; Thyroiditis