{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:51:38Z","timestamp":1791442298946,"version":"4.3.3"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":279,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Rheumatology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Systemic lupus erythematosus (SLE), Sj\u00f6gren\u2019s syndrome (SS), and ankylosing spondylitis (AS) are distinct immune\u2010mediated diseases with different classification frameworks and usual treatment approaches. Coexistence of all three disorders in a single patient is rare and creates diagnostic and therapeutic challenges. We report a 40\u2010year\u2010old woman with longstanding SLE, SS associated with SLE, and subsequently recognized axial spondyloarthritis (axSpA)\/AS. The patient fulfilled the 2019 ACR\/EULAR classification criteria for SLE (total score \u2265\u200910), the 2016 ACR\/EULAR classification criteria for primary SS (total score \u2265\u20094), and the 2009 ASAS classification criteria for axSpA through both the imaging and clinical arms. Conventional treatment options were limited by prior gastrointestinal bleeding with NSAIDs and concern for drug\u2010induced lupus\u2010like syndromes with TNF inhibitors. The patient remained stable on hydroxychloroquine 200\u2009mg daily and was enrolled in a Phase 2 SLE clinical trial evaluating a JAK inhibitor. Treatment assignment was unknown during the blinded period; during the unblinded continuation phase, she was confirmed to be receiving upadacitinib 15\u2009mg daily. Over a 6\u2010month duration of confirmed upadacitinib exposure, clinical improvement in lupus\u2010 and sicca\u2010related symptoms were observed, and follow\u2010up MRI showed resolution of previously documented sacroiliitis. Although causality cannot be established from a single uncontrolled observation, the clinical and imaging improvement during confirmed upadacitinib exposure is hypothesis\u2010generating and suggests that shared inflammatory pathways may warrant further investigation in selected overlap cases.<\/jats:p>","DOI":"10.1155\/crrh\/2532559","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:14:42Z","timestamp":1791440082000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Rare Autoimmune Triad: Coexistence of Systemic Lupus Erythematosus, Sj\u00f6gren\u2019s Syndrome, and Ankylosing Spondylitis: A Case Report"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5103-8189","authenticated-orcid":false,"given":"Gianna","family":"Sagona","sequence":"first","affiliation":[{"name":"University of Illinois College of Medicine Rockford  Rockford Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9735-8507","authenticated-orcid":false,"given":"Frank","family":"Schwartz","sequence":"additional","affiliation":[{"name":"University of Illinois College of Medicine Rockford  Rockford Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7093-0500","authenticated-orcid":false,"given":"Molly","family":"Nguyen","sequence":"additional","affiliation":[{"name":"University of Illinois College of Medicine Rockford  Rockford Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saad","family":"Tariq","sequence":"additional","affiliation":[{"name":"Department of Rheumatology University of Illinois College of Medicine  Rockford Illinois USA  uic.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"e_1_2_10_1_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2018-214819"},{"key":"e_1_2_10_2_2","first-page":"35","article-title":"American College of Rheumatology\/European League Against Rheumatism Classification Criteria for Primary Sj\u00f6gren\u2019s syndrome","volume":"69","author":"Shiboski C. 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