Overlap between systemic sclerosis and rheumatoid arthritis: a distinct clinical entity?

Horimoto, Alex Magno Coelho; Costa, Izaías Pereira da

doi:10.1016/j.rbre.2014.12.011

Cited by 15 publications

(15 citation statements)

References 41 publications

(69 reference statements)

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“…6,[14][15][16][17] Moreover, Horimoto and Costa found a-CCP antibodies in 4 out of 24 patients (16.7%), but all patients had an SSc-RA overlap syndrome. 9 Based on literature data, we can suppose that a-CCP antibodies are a useful marker in identifying patients diagnosed with an SSc-RA overlap syndrome; however, these antibodies may also be positive in 7% of SSc patients without arthritis. 15 In our study, we also detected a-CCP antibodies in 10% of SSc patients without joint involvement.…”

Section: Discussionmentioning

confidence: 97%

“…According to our research, the prevalence of RF in SSc ranged from 12% to 35% and may be positive in SSc patients without joint manifestations. 1,6,9,15,18,19 Avouac et al suggested that the RF test seems non-specific and does not distinguish SSc patients with musculoskeletal manifestations from those unaffected by them. 19 Rheumatoid factor may also be seen in patients with SSc associated with secondary Sjögren's syndrome, which is not uncommon in SSc patients.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Symmetrical polyarthritis similar to rheumatoid arthritis (RA) can also be found in SSc, but it particularly characterizes a systemic sclerosis-rheumatoid arthritis (SSc-RA) overlap syndrome. 2,[8][9][10] In some cases, arthritis in the course of SSc and SSc-RA overlap syndrome can be very difficult to distinguish. It is known that the main serological markers for diagnosing RA are anti-citrullinated protein (a-CCP) antibodies and rheumatoid factor (RF).…”

Section: Introductionmentioning

confidence: 99%

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Anti-CCP antibodies and rheumatoid factor in systemic sclerosis: Prevalence and relationships with joint manifestations

Wielosz¹,

Majdan²,

Dryglewska³

et al. 2018

Adv Clin Exp Med

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Anti-CCP antibodies and rheumatoid factor in systemic sclerosis: Prevalence and relationships with joint manifestations

Wielosz¹,

Majdan²,

Dryglewska³

et al. 2018

Adv Clin Exp Med

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“…Overlap syndromes or the presence of a second CTD can occur in 30%-52% of patients who have a diagnosis of SLE, RA and SSc/Scl [8].The proportion of patients described as having scleroderma overlap syndromes is greater [9,10]. Unlike Scl overlaps, well-defi ned overlap syndromes with SLE are unusual.…”

Section: Discussionmentioning

confidence: 99%

Interstitial Lung Disease and Pulmonary Arterial Hypertension in Overlap Syndrome: A Case Report

Frio¹,

Navarra²

2019

jmust

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OBJECTIVE To present the onset of severe pulmonary arterial hypertension (PAH) in a patient with interstitial lung disease (ILD) associated with overlap syndrome. CASE PRESENTATION A 42-year-old female was diagnosed with overlap syndrome consisting of systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and rheumatoid arthritis (RA). The serologic profi le included positive antinuclear antibody (ANA), anti-dsDNA, anti-RNP, anti-Ro, anti-Scl70, anti-Sm, rheumatoid factor and hypocomplementemia (C3, C4). She had chronic stable ILD for 17 years maintained on hydroxychloroquine (HCQ), prednisone 5 mg/day and indacaterol. The current admission was due to progressive dyspnea and right-sided heart failure over the past month. Chest radiograph showed pulmonary congestion, and 2-dimensional echocardiography (2DE) disclosed severe PAH with systolic pulmonary arterial pressure (SPAP) of 76 mmHg by tricuspid regurgitation (TR) jet, dilated right ventricle (RV) with poor systolic function, moderate pericardial effusion with no signs of tamponade. She received furosemide, beraprost, sildenafi l, and prednisone was increased to 20 mg/ day. Two weeks following discharge, there was complete resolution of symptoms and repeat 2DE showed non-dilated RV with good systolic function, normal SPAP of 21.4 mmHg and minimal pericardial effusion. Prednisone was tapered to 5 mg/day; beraprost, sildenafi l and HCQ were continued. CONCLUSION Overlap syndrome was diagnosed by the combination of clinical features and serology distinctive of SLE, SSc and RA. Her illness, particularly ILD, was adequately controlled over several years, until the recent onset of PAH complicated by right-sided heart failure. The dramatic response to high-dose steroids is more consistent with infl ammatory vasculitis of SLE activity rather than fi brosis typical of SSc.

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“…Подобно РА, вовлечение кистей часто бывает первым клиническим проявлением ССД. При ССД может развиться симметричный полиартрит, который иногда сложно дифференцировать от РА и наличие которого может указывать на перекрестный синдром ССД + РА [56,57]. Развитие эрозивного артрита у больных с ССД с большой вероятностью указывает на наличие перекрестного синдрома ССД -РА [58,59].…”

Section: конфликт интересовunclassified

Mixed connective tissue disease, undifferentiated connective tissue disease and overlap syndromes

Алекперов

2019

Alʹm. klin. med.

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Systemic lupus erythematosus, systemic sclerosis, inflammatory myopathy and rheumatoid arthritis are systemic connective tissue disorders which are characterized by heterogeneous clinical symptoms and variable course. To date, updated diagnostic criteria for early diagnosis of each of the diseases of this group have been proposed. At the same time, a proportion of patients already have at the onset of the disease or over time, a combination of signs characteristic of different diseases. Such conditions are referred to as mixed connective tissue disease, undifferentiated connective tissue disease or overlap-syndrome, whose nosological identity remains the subject of discussion. Formerly there has been a kind of terminological confusion and similar conditions were described under different names, depending on the author's preferences. It was also believed that these conditions were an early stage or a clinically "incomplete" form of a connective tissue disease. However, as the observations of large patient groups have shown, whose disease was represented by a number of individual signs of several connective tissue diseases, the clinical manifestation remains unchanged for many years in the majority of them. To recognize the right for nosological independence, one should account for the fact that only for a mixed connective tissue disease various authors and research groups have proposed four variants of diagnostic criteria. These criteria have small differences in the number of clinical signs; however, all criteria include a mandatory sign, i.e. the presence of antibodies to U1-ribonucleoprotein in high titers. Clinical signs common to all these diagnostic criteria include the Raynaud's syndrome, arthritis, myositis and finger swelling or sclerodactyly. Another patient category includes those with mono- or oligosymptomatic manifestations characteristic of systemic connective tissue diseases, but without any specific immunological markers. Some of these patients in a fairly short time, usually from several months to 1–2 years, develop other clinical symptoms and signs corresponding to a reliable diagnosis of a connective tissue disease. At the same time, a significant part of patients with the oligosymptomatic course demonstrate a long-term stability without any further evolution of the disease. Such cases are defined as an undifferentiated connective tissue disease. To avoid the erroneous diagnosis of the transient form or an early stage of any connective tissue disease, the proposed classification criteria, along with the inclusion criteria, also embrace clinical and serological exclusion criteria. A separate category consists of patients with a combination of clinical signs sufficient for a definitive diagnosis of at least two systemic connective tissue diseases. These patients are diagnosed with the overlap-syndrome with indication of the components of connective tissue diseases in each individual case, as it largely determines the individual treatment and prognosis. The possibility of such clinical variants of systemic connective tissue diseases is becoming increasingly justified due to the concept of polyautoimmunity, which has attracted great interest of researchers in the last few years.

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Overlap between systemic sclerosis and rheumatoid arthritis: a distinct clinical entity?

Cited by 15 publications

References 41 publications

Anti-CCP antibodies and rheumatoid factor in systemic sclerosis: Prevalence and relationships with joint manifestations

Anti-CCP antibodies and rheumatoid factor in systemic sclerosis: Prevalence and relationships with joint manifestations

Interstitial Lung Disease and Pulmonary Arterial Hypertension in Overlap Syndrome: A Case Report

Mixed connective tissue disease, undifferentiated connective tissue disease and overlap syndromes

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