INTRODUCTION: The term "Rhupus" was employed to descriptively illustrate the overlap observed in some pediatric patients displaying features of both juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE). Although "Rhupus" is traditionally used in adults, we applied it broadly to emphasize this clinical overlap. METHODS: We sought to identify studies that registered signs, symptoms, imaging characteristics, and treatments given to patients with JIA and SLE. We searched four databases using a Boolean search string, resulting in 231 articles after duplicate removal. Title and abstract screening yielded 57 articles for full-text assessment. Full reviewed 13 extracted data regarding sex, age of onset, serologic and imaging findings, and management strategies. The NIH quality assessment tool was applied to ensure the internal validity of the articles. RESULTS: From the 13 articles evaluated that meet inclusion criteria, none had standardized diagnostic algorithms. The total number of patients in those articles is 26, without discussing treatment guidelines. DISCUSSION: Clinical presentation, diagnostic parameters, and treatment of pediatric Rhupus were synthesized in this review. Fundamental keys help distinguish the joint presentation when Juvenile Idiopathic Arthritis or Lupus is present, compared with the signs and symptoms when developing the overlapping syndrome. We highlight the importance of physicians knowing about this rare condition and call all specialists to report new cases of the disease so a consensus can be reached to establish standardized guidelines for diagnosing and treating Rhupus syndrome.
Arthritis, Juvenile , Arthritis, Rheumatoid , Lupus Erythematosus, Systemic , Adult , Humans , Child , Arthritis, Juvenile/diagnosis , Arthritis, Rheumatoid/drug therapy , Lupus Erythematosus, Systemic/drug therapy , Syndrome
Metallosis is a late uncommon complication of knee arthroplasties due to prosthetic loosening or component displacement. Oxinium prosthesis used to have components that attempted and proved to decrease prosthetic wear and consequent metallosis in the past. However, new studies showed that a combination of a shallow anterior tab snap-fit locking mechanism and thin dovetail lips make it susceptible to polyethylene dislocation and prosthesis loosening. The following case report show metallosis development in a 69-year-old female patient with a 20-year history of stage IV left gonarthrosis (Kellgren and Lawrence classification) who underwent a total knee arthroplasty (TKA) with a high-flex PS Genesis II prosthesis (Smith & Nephew, Hertfordshire, UK). We discuss the role of the material and her rheumatoid arthritis background in orthopedic mechanical failure. It is crucial that designers focus on the improvement of locking mechanisms and polyethylene properties.
