Case Report

Do Two Clinically Distinct Inflammatory Arthritides” Rheumatoid Arthritis and Axial Spondyloarthritis” Coexist

DOI https://doi.org/10.70302/jpsim.v6i1.2516
Received: 19 Nov 2024 Revised: 20 Feb 2025 Accepted: 24 Feb 2025 Published Online: 10 Mar 2025

Abstract

Rheumatoid arthritis and spondyloarthrides are autoimmune diseases with variable age spectrum at presentation, multi organ involvement but specifically targeting joints in clinically distinct pattern leading to joint damage, making sometimes patient physical activity limited if timely diagnosis and immediate treatment delayed. Previously clinicians often faced difficulty in making earlier diagnosis of Rheumatological diseases due to lack of understanding of correlation of underlying autoimmunity with such diseases and polymorphic inheritance of associated genes but now definite diagnostic criteria made on extensive clinical research by different Rheumatological societies. Moreover radiological advances make it further easier to diagnose seronegative/asymptomatic cases earlier. Presence of two rheumatological diseases at a time in same person of any age group though rare but chances are here in accordance to Meta analysis of different case studies presenting with symptoms not particular for one Rheumatological disease. We are going to report a case of young female patient initially presented with polyarthritis, diagnosed and treated as RA but later having backache, when investigated further, HLA B27. Radiological features were suggestive of early Sacroillitis.

Keywords
Rheumatoid arthritis (RA) Spondyloarthritis (SpA) Rheumatoid factor (RAF) anti cyclic citrulinated peptide (CCP) HLA B27 LBP schober Sacroillitis csDMARDs tsDMARDs biologics.

How to Cite This Article

Haroon M, Ahmed NM. Do Two Clinically Distinct Inflammatory Arthritides” Rheumatoid Arthritis and Axial Spondyloarthritis” Coexist. J Pak Soc Intern Med. 2025;6(1):78–81. doi:10.70302/jpsim.v6i1.2516

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Conflict of Interest

All authors declare no competing interests.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

No specific funding was received for this research.

Funder information follows the Crossref Funder Registry standard.

References

  1. Maksymowych WP, Brown MA. Genetics of ankylosing spondylitis and rheumatoid arthritis: where are we at currently, and how do they compare? Clin Exp Rheumatol. 2009;27(4 Suppl 55):S20–S25.
  2. Kahn MF. The history of rheumatoid factor. Rev Rhum Engl Ed. 1995;62(7-8):513-7.
  3. Zimmermann-Górska I and Wewnetętrznych PC. Interna Szczeklika. Podręcznik chorób wewnętrznych. Kraków: Medycyna Praktyczna; 2014. Choroby reumatyczne; pp. 1791-1982.
  4. Deodhar A, Mittal M, Reilly P, Bao Y, Manthena S, Anderson J, et al. Ankylosing spondylitis diagnosis in US patients with back pain: identifying providers involved and factors associated with rheumatology referral delay. Clin Rheumatol. 2016; doi: 10.1007/s10067-016-3231-z. doi:10.1007/s10067-016-3231-z
  5. Zhao SS, Pittam B, Harrison NL, Ahmed AE, Goodson NJ, Hughes DM. Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis. Rheumatol (Oxford). 2021;60(4):1620-8.
  6. C. Romão V, Santos MJ, Polido-Pereira J, Duarte C, Nero P, Miguel C, Costa JA, et al. Comparative effectiveness of tocilizumab and TNF inhibitors in rheumatoid arthritis patients: data from the Rheumatic Diseases Portuguese Register, Reuma. pt. BioMed Res Int. 2015;2015(1):279890.
  7. Rudwaleit MV, Van Der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777-83.

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