{
  "abstract": "Introduction Systemic sclerosis (SSc) and ankylosing spondylitis (AS) rarely coexist, and only a limited number of cases have been reported(1-9). Emerging evidence highlights the role of the JAK/STAT pathway in both fibrotic and inflammatory mechanisms, suggesting potential benefit of selective JAK-1 inhibition in SSc and AS (10). Upadacitinib has demonstrated anti-fibrotic and anti-inflammatory effects in preclinical SSc models and early clinical experience (11,12).Material and Methods We report a 61-year-old woman referred to rheumatology by ophthalmologist due to anterior uveitis. She described a 25-year history of inflammatory back pain, Raynaud’s phenomenon, hand swelling, and progressive skin thickening. Physical examination revealed sclerodactyly, telangiectasias, reduced oral aperture, and a positive Mennell sign. Laboratory evaluation showed ANA 4+ with centromere pattern and positive anticentromere antibodies, as well as HLA-B27 positivity. Nailfold capillaroscopy demonstrated an active scleroderma pattern. MRI of the sacroiliac joints revealed bone marrow edema, and lumbar spine radiographs demonstrated bridging syndesmophytes. Pulmonary function tests, HRCT of the lungs, and echocardiography were unremarkable. The patient fulfilled diagnostic criteria for limited cutaneous systemic sclerosis and ankylosing spondylitis.Results Methotrexate was initiated for uveitis and SSc-related manifestations, followed by upadacitinib to address AS activity and potential benefit for SSc. After three months, significant clinical improvement was observed: ASDAS decreased from 3.4 to 1.1, the modified Rodnan skin score improved from 13 to 4, and capillaroscopy showed mild regenerative changes. No progression of visceral involvement was detected. These findings align with recent data demonstrating anti-fibrotic effects of selective JAK-1 inhibition in SSc (11) and favorable clinical outcomes in refractory disease(12).Conclusions This case illustrates a rare overlap of SSc and AS and highlights the potential dual therapeutic benefit of upadacitinib. Selective JAK-1 inhibition led to marked improvement in axial inflammation and cutaneous fibrosis, suggesting that upadacitinib may represent a promising treatment option in complex overlap syndromes involving both inflammatory and fibrotic pathways.",
  "authors": [
    {
      "affiliations": [
        "Department of Rheumatology, Internal Medicine Clinic, Clinical Center of Montenegro, Podgorica, Montenegro"
      ],
      "name": "Milan Bogojevic"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Internal Medicine Clinic, Clinical Center of Montenegro, Podgorica, Montenegro"
      ],
      "name": "Milica Markovic Vlaisavljevic"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Internal Medicine Clinic, Clinical Center of Montenegro, Podgorica, Montenegro"
      ],
      "name": "Rifat Medjedovic"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Internal Medicine Clinic, Clinical Center of Montenegro, Podgorica, Montenegro"
      ],
      "name": "Natasa Miketic"
    },
    {
      "affiliations": [
        "Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy, Milano, Italy"
      ],
      "name": "Marco Matucci Cerinic"
    }
  ],
  "title": "P.339 Upadacitinib in a rare systemic sclerosis–ankylosing spondylitis overlap",
  "uid": "40550e83-abd0-57df-808b-54e8237dc7ab"
}