Keywords
axial spondyloarthritis
HLA-B27
methotrexate
tocilizumab
synovitis
spondylitis
Categories
How to Cite
Abstract
In the past, rheumatoid arthritis and axial spondyloarthritis were considered mutually exclusive diseases because of their distinct genetic and clinical profiles. We present the case of a 74-year-old man with seropositive rheumatoid arthritis and long-standing axial spondyloarthritis, illustrating the diagnostic and therapeutic challenges associated with this rare overlap. The patient presented with symmetrical erosive-destructive polyarthritis involving joints of the upper extremities, strongly positive immunological markers, a history of chronic inflammatory low back pain beginning at approximately 35 years of age, positive HLA-B27, radiographic sacroiliitis and spondylitis with syndesmophyte formation and complete bony bridges between vertebral bodies. Given the predominant clinical manifestations, the presence of concomitant prostate carcinoma, and having in mind the urological consultation, combination therapy with methotrexate and tocilizumab was initiated, resulting in low disease activity. This case highlights the challenges in diagnosing and treating patients with two distinct inflammatory joint diseases and discusses the importance of individualized therapeutic strategies.
References
1. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388(10055):2023–2038. doi:10.1016/S0140-6736(16)30173-8
2. Van der Heijde D, Ramiro S, Landewé R, et al. ASAS/EULAR recommendations for the management of axial spondyloarthritis. Ann Rheum Dis. 2017;76(6):978–991. doi:10.1136/annrheumdis-2016-210770
3. Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390(10089):73–84.
4. Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis. Arthritis Rheum. 2011;63(3):860–869. doi:10.1002/art.30132
5. Ciurea A, Scherer A, Weber U, et al. Coexistence of rheumatoid arthritis and ankylosing spondylitis: myth or reality? Case Rep Rheumatol. 2022;2022:8500567. doi:10.1155/2022/8500567
6. Zhang Y, Feng B, Dong J, et al. Rheumatoid arthritis coexisting with ankylosing spondylitis: a report of 22 cases with delayed diagnosis. Medicine (Baltimore). 2021;100(13):e25051. doi:10.1097/MD.0000000000025051
7. Neva MH, Kauppi MJ. Cervical spine involvement in rheumatoid arthritis. Ann Rheum Dis. 2006;65(2):136–141. doi:10.1136/ard.2004.033483
8. European Medicines Agency. Recommendations to minimise risk of serious side effects with JAK inhibitors for chronic inflammatory disorders. 2022. Available from: https://www.ema.europa.eu/en/news/recommendations-minimise-risk-serious-side-effects-jak-inhibitors
9. Dougados M, van der Heijde D, Sieper J, et al. Randomized trial of tocilizumab in ankylosing spondylitis. Ann Rheum Dis. 2014;73(1):95–100. doi:10.1136/annrheumdis-2012-202744
10. Curtis JR, Xie F, Chen L, et al. Safety of combination therapy with two bDMARDs in patients with rheumatoid arthritis: systematic review and meta-analysis. Arthritis Res Ther. 2018;20:186. doi:10.1186/s13075-018-1711-0
11. Sebbag E, Lauper K, Molina-Collada J, et al. 2024 EULAR points to consider on the initiation of targeted therapies in patients with inflammatory arthritis and a history of cancer. Ann Rheum Dis. 2024 Dec 20. doi:10.1136/ard-2024-225982
12. Ramiro S, Nikiphorou E, Sepriano A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. 2022;82(1):20–29. doi:10.1136/annrheumdis-2021-220556
13. Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological DMARDs. Ann Rheum Dis. 2020;79(6):685–699. doi:10.1136/annrheumdis-2019-216655
14. Barczyńska TA, Węgierska M, Żuchowski P, et al. Coexistence of rheumatoid arthritis and ankylosing spondylitis. Reumatologia. 2015;53(5):279–285. doi:10.5114/reum.2015.53995
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Copyright (c) 2026 G. Kotov, V. Terzieva, P. Ermencheva, M. Ivanova (Author)