Nothing Is Impossible: A Case Report of an Unusual Association of Rheumatologic Diseases

Oana-Mădălina Mistreanu^(1,2), Bianca-Margareta Dumitrescu^(1,2,*), Corina-Delia Mogoșan^(1,2), Cătălin Codreanu^(1,2)

1)“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2)“Dr. Ion Stoia” Clinical Centre for Rheumatic Diseases, Bucharest, Romania

Background: The coexistence of multiple rheumatic diseases in a single patient is uncommon but clinically significant.
Case Report: We report a 65-year-old female patient with rheumatoid arthritis (RA) and ankylosing spondylitis (AS), who developed subacute cutaneous lupus induced by sulfasalazine (DISL). AS was active so she was treated with secukinumab 150 mg monthly for five years, escalated to 300 mg due to cervical enthesitis. Partial response after five months led to a switch to etanercept, which improved joint symptoms but triggered DISL recurrence with anti-Ro52 positivity. Subsequently, sicca symptoms appeared, and Sjögren's syndrome was confirmed by biopsy. Upadacitinib 15 mg/day was initiated, resulting in remission of both musculoskeletal and cutaneous symptoms.
Conclusion: This case illustrates the diagnostic and therapeutic complexity of overlapping RA, AS, DISL, and Sjögren's syndrome. It underscores the risk of cutaneous adverse reactions to both synthetic and biologic DMARDs and highlights the importance of multidisciplinary monitoring and tailored treatment strategies.

Keywords: rheumatoid arthritis, ankylosing spondylitis, drug-induced subacute cutaneous lupus, sjogren's syndrome, upadacitinib

Corresponding author(s): Bianca-Margareta Dumitrescu, Dr. Ion Stoia” Clinical Centre for Rheumatic Diseases, Bucharest, Romania; email: Bia1mar@yahoo.com