Opinion: Erosive Changes Questioned in RA/Lupus Overlap Syndrome

I read with interest the Diagnostic View (TR, April), which, according to the authors, represented a case of rhupus, an overlap syndrome of RA and SLE. I challenge this view.

My arguments: In the case of erosive RA, typically erosive changes are seen at MTP joints other than MTP1 (e.g., MTP5). In addition, the erosive changes seen at the MTP1s look weird. On the left side, the first metatarsal is shortened and the proximal phalanx looks like a Mexican cap. Maybe a case of RA-SLE-psoriatic arthritis? Post-surgery? Is there an associated gout? We were not told the level of uric acid.

George A.W. Bruyn, MD, PhD

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