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Overlapping juvenile idiopathic arthritis and systemic lupus erythematosus: a case report

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Abstract

Hereby, we report the case of a 12-year-old girl developing oligoarthritis and progressing into a polyarticular form. Rheumatoid factor was positive, and juvenile idiopathic arthritis (JIA) was diagnosed. After a poor response to DMARDs, an anti-TNF agent (infliximab) was initiated, but to be discontinued due to an allergic reaction. The same complication was observed with the fully human derivative, adalimumab. At the age of 22, the patient presented septicemia with severe anemia and subsequent development of leukopenia, myocarditis with heart failure, and ANA, aSm, aSS-A, aCL positives, and nephrotic syndrome. These new clinical manifestations fulfilled the classification criteria for the diagnosis of systemic lupus erythematosus. Due to the poor therapeutic responses for both diseases, alternative medical options have to be considered, such as targeted therapy with anti-CD20 or interleukin-6 receptor antagonist monoclonal antibodies. This patient may also be a candidate for autologous hemopoietic stem cell transplantation.

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Abbreviations

JIA:

Juvenile idiopathic arthritis

RA:

Rheumatoid arthritis

EULAR:

European league against rheumatism

ILAR:

International league against rheumatism

RF:

Rheumatoid factor

SLE:

Systemic lupus erythematosus

ANA:

Antinuclear antibody

a-dsDNA:

Antibody against double stranded

a-CL:

Anti-cardiolipin antibodies

aCCP:

Anti-citrullinated peptide antibody

NSAID:

Non-steroidal anti-inflammatory drugs

DMARDs:

Disease-modifying anti-rheumatic drugs

ACPA:

Anti-citrullinated peptide antibody

aSM:

Smith antigen

aSS-A:

Sjögren syndrome A antigen

ISN/RPS:

International society of nephrologist/renal pathology society

ENA:

Anti-extractable-nuclear—antibody

TNF-α:

Tumor-necrosis factor alfa

E. coli:

Escherichia coli

anti-TNF:

Anti-tumor-necrosis factor

ATIL:

Anti-TNF-induced lupus

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Acknowledgments

The authors are greatly thankful to Marco Gattorno MD, PhD (2nd Division of Pediatrics, EULAR Centre of Excellence in Rheumatology, Genova, Italy), Péter Fülöp, MD, PhD (1st Dept. of Internal Medicine, University of Debrecen Medical and Health Science Center, Debrecen, Hungary), Péter Szodoray MD, PhD (Institute of Immunology, Rikshospitalet, University of Oslo) for their kind remarks and recommendations.

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Authors and Affiliations

  1. National Institute of Rheumatology and Physiotherapy, Budapest, Hungary

    Anna Bazsó, Krisztina Sevcic, Ilonka Orbán, Gyula Poór, Zsolt Balogh & Emese Kiss

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  1. Anna Bazsó
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  2. Krisztina Sevcic
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  3. Ilonka Orbán
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Correspondence to Anna Bazsó.

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Bazsó, A., Sevcic, K., Orbán, I. et al. Overlapping juvenile idiopathic arthritis and systemic lupus erythematosus: a case report. Rheumatol Int 31, 695–698 (2011). https://doi.org/10.1007/s00296-010-1594-z

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  • DOI: https://doi.org/10.1007/s00296-010-1594-z

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