Differences and Similarities Between Children and Adults With Rhupus Syndrome

Area of Science:

• Rheumatology
• Pediatric Rheumatology
• Immunology

Background:

• Rhupus syndrome, a condition overlapping rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), presents unique challenges in both pediatric and adult populations.
• Understanding the distinct characteristics of rhupus in different age groups is essential for accurate diagnosis and tailored treatment.

Purpose of the Study:

• To comprehensively evaluate and compare the clinical characteristics, disease manifestations, and treatment patterns of pediatric and adult patients diagnosed with rhupus syndrome.
• To identify significant differences and similarities between these two patient cohorts to inform future research and clinical practice.

Main Methods:

• A comparative study involving 30 pediatric and 15 adult patients diagnosed with rhupus syndrome.
• Evaluation of demographic data, clinical phenotypes at onset and last visit, laboratory findings, and treatment modalities used for both juvenile idiopathic arthritis (JIA)/rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) components.

Main Results:

• Adults had a longer diagnostic delay between JIA/RA and SLE diagnosis compared to pediatric patients.
• Pediatric patients showed higher frequencies of cutaneous findings, oral ulcers, hematological/renal involvement, hypocomplementemia, and anti-dsDNA positivity, with a predilection for SLE at the last visit.
• Adults more commonly presented with constitutional symptoms, nonscarring alopecia, neuropsychiatric involvement, anti-CCP positivity, symmetric polyarthritis, and erosive arthritis, with a predilection for RA at the last visit.
• Treatment variations included mycophenolate mofetil and rituximab more frequently in pediatric and adult patients, respectively, for SLE, and leflunomide more in adults for JIA/RA.

Conclusions:

• This study represents the first direct comparison of pediatric and adult rhupus patients, highlighting significant age-related differences in disease presentation and management.
• The findings underscore the importance of recognizing these distinct characteristics to optimize diagnostic and therapeutic strategies for rhupus across the lifespan.
• Further research is warranted to elucidate the underlying mechanisms driving these observed differences and to develop age-specific treatment guidelines.