Association of ANCA-associated vasculitis-rheumatoid arthritis overlap syndrome in four patients: Rituximab may be the right choice?

Abstract

Objectives: There have been few reports on the association of rheumatoid arthritis (RA) with anti-neutrophil cytoplasmic antigen (ANCA)-associated systemic vasculitides. Methods: Here we present four cases of RA overlapping with Wegener's granulomatosis (WG), microscopic polyangiitis (MPA) and Churg-Strauss syndrome (CSS). All these cases had both the diagnosis of RA and that of ANCA-associated vasculitis. Results: After we tried corticosteroids, multiple immunosuppressive drugs, sometimes plasmapheresis, rituximab was introduced to 3 out of 4 cases. Rituximab therapy was found to be effective in these three overlap cases. In the fourth case, rituximab was and will be considered; however, the patient has not given consent. Conclusion: To our knowledge, this is the first report on RA+CSS association. Common pathogenic background, such as genetic predisposition and ANCA may account for the development of RA+vasculitis overlaps. In DMARD-refractory cases, such as the ones presented here, biologics, especially rituximab may be highly effective.

Keywords::

• Rheumatoid arthritis
• ANCA-associated vasculitis
• Wegener's granulomatosis
• Churg-Strauss syndrome
• microscopic polyangiitis
• rituximab

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.