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The Coexistence of Microscopic Polyangiitis and Rheumatoid Arthritis: A Case Report.
Claudia S Villa Celi1, Valeria Turcan1, Juan Sosa1
1Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA.
Cureus
|August 5, 2024
Summary
Microscopic polyangiitis (MPA) and rheumatoid arthritis (RA) can coexist, presenting diagnostic challenges. Early recognition and immunosuppressive therapy are crucial for managing this rare overlap syndrome and preventing severe kidney and lung complications.
Area of Science:
- Rheumatology
- Nephrology
- Pulmonology
Background:
- Microscopic polyangiitis (MPA) is a rare autoimmune small vessel vasculitis, often associated with antineutrophil cytoplasmic antibodies (ANCA).
- Rheumatoid arthritis (RA) is a chronic inflammatory disorder primarily affecting joints.
Observation:
- A 58-year-old male with a history of RA presented with acute dyspnea, hypoxemic respiratory failure, anemia, acute kidney injury, hematuria, and proteinuria.
- Chest CT revealed bilateral infiltrates, and bronchoscopy suggested diffuse alveolar hemorrhage (DAH).
Findings:
- The patient tested positive for rheumatoid factor (RF), perinuclear ANCA (p-ANCA), anti-myeloperoxidase (anti-MPO), and antinuclear antibody (ANA).
- Kidney biopsy confirmed MPA with pauci-immune necrotizing glomerulonephritis, indicating an MPA-RA overlap syndrome.
Implications:
- This case highlights the diagnostic complexity of MPA coexisting with RA.
- Prompt immunosuppressive treatment is vital for managing MPA-RA overlap syndrome and averting pulmonary and renal damage.
- Assessing ANCA serology in RA patients with respiratory or renal symptoms is recommended.
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