Systemic sclerosis (SSc) is an autoimmune
rheumatic disease characterised by vasculopathy,
inflammation and
fibrosis in multiple organs and occasionally coexists with rheumatic conditions, such as
axial spondyloarthritis (
axSpA). The aim of this study was to demonstrate the successful use of
tofacitinib in SSc and axial
spondylarthritis (
axSpa), as a novel therapeutic agent; however, further studies are needed to elucidate the role of JAK inhibition in the treatment of both conditions. In this paper, we report a case of a 58-year-old woman with diffuse SSc who developed
axSpA. The patient had a 10-year history of SSc and was treated with
tocilizumab before the onset of
lower back pain. The diagnostic evaluation included MRI that demonstrated bone marrow oedema in the sacroiliac joints, the
HLA-B27 was positive, and given the inflammatory features of her
back pain, she was diagnosed with
axSpa. The
biologic agent was switched into
etanercept with an improvement of the
back pain; however, the patient had a relapse of her
skin manifestations. Given the treatment failure, we aim to treat the 2 coexisting conditions concurrently with
tofacitinib, which led to symptom improvement. This case report is noteworthy, given the rarity of the coexistence of both conditions and the therapeutic challenges faced by the clinician. The online database MEDLINE/PubMed and Scopus where searched for articles published from inception to June 2020, using the terms "
ankylosing spondylitis" AND "
systemic sclerosis" OR "
axial spondyloarthritis" AND "
systemic sclerosis". Also, we searched the American College of Rheumatology and European League Against
Rheumatism annual meeting abstracts from 2015 to 2019 using the same terms. As a result, we found 9 similar case reports. 9 case reports of patients with both conditions were identified through a literature review and we highlighted the differences and similarities between them. Also, we emphasise on intracellular signalling inhibitors as novel therapeutic targets in treating both conditions.
Tofacitinib might be a novel therapeutic agent in the management of SSc and
axSpA.