EC Pulmonology and Respiratory Medicine

Rhupus syndrome is a rare overlap condition characterized by the coexistence of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). It presents a unique challenge due to the complexity of its clinical manifestations and the overlap of symptoms from both diseases. This case report aims to contribute to the understanding of Rhupus syndrome through the examination of a patient exhibiting characteristic features of both RA and SLE, with a focus on diagnostic strategies and therapeutic management.

A 46-year-old male patient with a history of hypertension and long-term exposure to automotive chemicals presented with symptoms of dry cough, inflammatory joint pain, and systemic features such as xerostomia and xeropthalmia. Diagnostic evaluation revealed classic signs of both RA and SLE, including positive rheumatoid factor, anti-cyclic citrullinated peptide antibodies, and anti-nuclear antibodies. Radiographic and thoracic imaging showed interstitial lung disease, with findings of diffuse opacities and honeycombing. Bronchoscopy indicated an inflammatory process without malignancy. The patient was diagnosed with Rhupus syndrome based on the combined clinical, serological, and imaging findings.

The patient was treated with corticosteroids and hydroxychloroquine to manage autoimmune activity, and was planned for antifibrotic therapy with Nintedanib following the confirmation of fibrosing pulmonary pathology. This therapeutic approach was tailored to address both the systemic autoimmune and specific pulmonary complications.

The case highlights the diagnostic challenges and therapeutic strategies associated with Rhupus syndrome. A review of similar cases in the literature was conducted, revealing that Rhupus often involves significant pulmonary complications and requires a nuanced approach to treatment. The patient's management strategy aligns with current best practices for managing complex autoimmune overlap syndromes, emphasizing the importance of personalized treatment.

Rhupus syndrome, though rare, requires careful diagnostic evaluation and a comprehensive treatment approach to manage the overlapping features of RA and SLE. This case underscores the need for continued research into the pathogenesis and management of Rhupus to improve patient outcomes.

 Keywords: Rhupus Syndrome; Rheumatoid Arthritis; Systemic Lupus Erythematosus; Overlap Syndrome; Case Report; Autoimmune Disease; Interstitial Lung Disease; Corticosteroids; Hydroxychloroquine; Nintedanib

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