title: Association of ANCA-associated vasculitis-rheumatoid arthritis overlap syndrome in four patients: rituximab may be the right choice?
abstract: OBJECTIVE
  There have been few reports on the association of rheumatoid arthritis (RA) with anti-neutrophil cytoplasmic antigen (ANCA)-associated systemic vasculitides.
  
  
  METHODS
  Here we present four cases of RA overlapping with Wegener's granulomatosis (WG), microscopic polyangiitis (MPA) and Churg-Strauss syndrome (CSS). All these cases had both the diagnosis of RA and that of ANCA-associated vasculitis.
  
  
  RESULTS
  After we tried corticosteroids, multiple immunosuppressive drugs, sometimes plasmapheresis, rituximab was introduced to 3 out of 4 cases. Rituximab therapy was found to be effective in these three overlap cases. In the fourth case, rituximab was and will be considered; however, the patient has not given consent.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report on RA+CSS association. Common pathogenic background, such as genetic predisposition and ANCA may account for the development of RA+vasculitis overlaps. In DMARD-refractory cases, such as the ones presented here, biologics, especially rituximab may be highly effective.
authors.affiliation: Department of Pulmonology, University of Debrecen Medical and Health Sciences Center, Debrecen, Hungary.
authors.forename: Mária
authors.initials: M
authors.lastname: Szilasi
authors.forename: János
authors.initials: J
authors.lastname: Mátyus
authors.forename: Ibolya
authors.initials: I
authors.lastname: File
authors.forename: Gabriella
authors.initials: G
authors.lastname: Szücs
authors.forename: Eva
authors.initials: E
authors.lastname: Rákóczi
authors.forename: György
authors.initials: G
authors.lastname: Pfliegler
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Szabó
authors.forename: Edit
authors.initials: E
authors.lastname: Végh
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Szekanecz
mesh_terms: D000328:Adult; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D019268:Antibodies, Antineutrophil Cytoplasmic; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology; D015267:Churg-Strauss Syndrome / Q000175:diagnosis / Q000276:immunology / Q000473:pathology; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis / Q000276:immunology / Q000473:pathology; D006801:Humans; D008297:Male; D055953:Microscopic Polyangiitis / Q000175:diagnosis / Q000276:immunology / Q000473:pathology; D008875:Middle Aged; D000069283:Rituximab; D013577:Syndrome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab