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Overlap Syndrome

Presentation

We present a case of a 62 year-old-male who presented with altered liver function tests, anemia and unintentional weight loss. Initial laboratories revealed anemia and a cholestatic pattern. [ncbi.nlm.nih.gov]

Entire Body System

  • Fever

    Low-grade fever. Raynaud phenomenon (reduced blood flow to the fingers, toes, ears, and nose, causing sensitivity, numbness, and loss of color in these areas). [my.clevelandclinic.org]

    Sweet's syndrome is characterized by fever, neutrophilia, erythematous skin lesions, and a diffuse dermal infiltrate of mature neutrophils. There are sets of associations that we will discuss in this article between OS and Sweet's syndrome. [ncbi.nlm.nih.gov]

    In addition to arthritis, fever, and Raynaud phenomenon, which occur in ASS, patients with anti-OJ antibodies appear to have more severe myositis. [ped-rheum.biomedcentral.com]

    […] treatment of Juvenile Idiopathic Arthritis, Systemic Lupus Erythematosus, Mixed Connective Tissue Disease, Juvenile Dermatomyositis, Morphea/Scleroderma, vasulitis (Wegener’s/GPA, MPA, Churg-Strauss, Henoch-Schonlein Purpura, Takayasu’s Arteritis), periodic fever [floatinghospital.org]

    A 47-year-old woman presented to the emergency department of our hospital in August, 2021, with a 2-day history of intractable nausea and vomiting (reminiscent of an area postrema syndrome) accompanied by fever and dizziness. [thelancet.com]

  • Anemia

    With aplastic anemia/PNH, both of those can be associated with anemia, although this happens for different reasons. [aamds.org]

    We present a case of a 62 year-old-male who presented with altered liver function tests, anemia and unintentional weight loss. Initial laboratories revealed anemia and a cholestatic pattern. [ncbi.nlm.nih.gov]

    At this time, she was treated with iron supplementation for normocytic hypochromic anemia (hemoglobin – Hb – of 9.5g/dL) and blood tests showed serum creatinine(sCr) of 1.5mg/dL (previous sCr 0.89mg/dL). [revistanefrologia.com]

    […] hypertension and lung hyperinflation have a further impact on cardiovascular function in patients with COPD. de Folgende Lebensmittel mit Ursprung in oder versandt aus China en Myelodysplastic/MPN overlap syndromes include rare entities such as refractory anemia [de.glosbe.com]

    Malar rash, autoimmune hemolytic anemia, neuropsychiatric lupus, and lupus nephritis are all less common in rhupus patients. [icliniq.com]

  • Swelling of the Finger

    She had a thin body habitus, acanthosis nigricans in multiple body folds ( Fig 2A ), hypertrichosis on the face and shoulders, and swelling of the finger tips (Raynauds phenomenon). [pediatrics.aappublications.org]

  • Congestive Heart Failure

    OSA is also associated with systemic hypertension which increases the risk of coronary artery disease, congestive heart failure, arrhythmias and stroke [28]. [cureus.com]

Respiratoric

  • Cough

    In contrast, an older patient with a history of tobacco smoking with chronic cough and dyspnea with evidence of fixed obstruction would favor a diagnosis of COPD. [mdedge.com]

    Symptoms of ACOS are likely to include: labored breathing wheezing coughing, with or without mucus tightness in the chest Symptoms vary from day to day and typically includes flare-ups. [healthline.com]

    Symptoms include: Difficulty breathing Excess mucus (more than usual) Feeling tired Frequent coughing Frequent shortness of breath Wheezing If you have asthma or COPD, it may be difficult to tell the difference between these two chronic lung diseases, [lung.org]

    Symptoms Signs of ACOS include: Difficulty breathing Wheezing Frequent coughing Tightness in the chest Excess phlegm Feeling tired Low physical tolerance for exercise Shortness of breath during routine activities Although symptoms may not always be severe [acaai.org]

    […] and mouth dryness, and need for humidification other factors affecting sleep disturbance such as insomnia, restless legs and shift work sleep hygiene cleaning and maintenance of equipment. 3.7.8 Be aware that some symptoms associated with COPD such as cough [nice.org.uk]

  • Sputum

    Plasma and sputum biomarkers The ongoing efforts in differential diagnosis of asthma-COPD overlap syndrome (ACOS) could not ignore plasma and sputum biomarkers. [jtd.amegroups.com]

    Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2014, http://www.everyday-breathing.com/media/15569/asthmacopdoverlap.pdf, accessed 3/7/17 Spears, et al., “Smoking in Asthma Is Associated with Elevated Levels of Corticosteroid Resistant Sputum [asthma.net]

    Measurement of blood eosinophils, unlike sputum eosinophil counts, is a well-standardised and reproducible test in most clinical laboratories. [erj.ersjournals.com]

    […] clinical phenotype as “overlap phenotype COPD-asthma” based on the presence of major and minor criteria. 9 Major criteria consisted of a postbronchodilator increase of forced expiratory volume in 1 second (FEV 1 ) ≥ 12% and ≥ 400 mL, and eosinophilia in sputum [mdedge.com]

    In smokers with severe obstructive bronchitis, sputum eosinophilia predicts a beneficial response to prednisone treatment [50]. [hindawi.com]

  • Exertional Dyspnea

    One year later, the patient was admitted to the Rheumatology Department with dyspnea on exertion and muscle weakness. [fortunejournals.com]

Gastrointestinal

  • Abdominal Pain

    In 2008 the patient was admitted to the hospital with anorexia, dyspepsia, ascites, abdominal pain and weight loss. Endoscopy showed esophageal varices and abdominal computed tomography revealed cirrhotic liver. [journalmc.org]

    Clinically, the patient reported no jaundice, dark urine, nausea or abdominal pain, fatigue or anorexia suggestive of acute viral hepatitis. [healio.com]

    Abdominal pain. Neuropathy (nerve disorders) affecting the trigeminal nerve in the face. Hearing loss. The "classic" symptoms of MCTD are: Raynaud phenomenon (see description above). [my.clevelandclinic.org]

    Brief Case Presentation A 17-year-old male with no significant past medical history presented with abdominal pain, diarrhea, vomiting, and elevated liver enzymes. His inflammatory markers were raised along with elevated lipase levels. [liverfellow.org]

    pain, or were investigated for elevated liver enzymes. [acgcasereports.gi.org]

Cardiovascular

  • Heart Disease

    This leads to long-term chronic health problems beyond the lungs (such as diabetes and heart disease) and their associated myriad complications. [sleepapnea.org]

    Sleep apnea, rather than being considered a leading cause of death, contributes to and is associated with the other top leading causes of death, including heart disease, cancer, accidents, stroke, diabetes and COPD. [sleepresolutions.com]

    The causes of death were progressive heart disease ( n = 2), myocardial infarction ( n = 2), respiratory failure due to interstitial lung disease (ILD) ( n = 1), sepsis ( n = 2), and unknown cause ( n = 1). [arthritis-research.biomedcentral.com]

    This leads to interrupted sleep and excessive daytime sleepiness and increases the risk of high blood pressure, heart disease, and stroke. [news-medical.net]

Skin

  • Eczema

    People with asthma often have allergies and the skin condition eczema. If you only have COPD, symptoms usually start after age 40. Symptoms can vary from day to day, but they’re chronic and progressive, even with treatment. [healthline.com]

    These variables will include diagnosis, GP visits, and prescriptions related to asthma and COPD, as well as history of allergy (including atopic eczema/dermatitis, food allergy, allergic rhinitis, and anaphylaxis) and smoking history (see Table 1 ). [nature.com]

Musculoskeletal

  • Arthritis

    Overlap syndromes typically have elements of systemic lupus erythematosus, rheumatoid arthritis, and progressive systemic sclerosis, among other illnesses. View Full Glossary [lupusresearch.org]

    Key Words: Systemic sclerosis; Rheumatoid arthritis 주제어: 전신경화증; 류마티스 관절염 [ekjm.org]

    Programs + Services | Doctors + Care Team | Research + Clinical Trials | News Programs + Services Rheumatology The Pediatric Rheumatology Division at Floating Hospital in Boston provides expert arthritis and inflammatory disorder diagnosis and treatment [floatinghospital.org]

    Arthritis Rheum 1982 ; 25 : 1271 –5. ↵ Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. [jcp.bmj.com]

    However, there are few reported cases of SSc-rheumatoid arthritis (RA) overlap-associated interstitial pneumonia. [ncbi.nlm.nih.gov]

  • Arthralgia

    A clinical examination revealed Raynaud phenomenon, arthralgia, distal skin sclerosis, and microbleeds in the nailfold capillaries. An anti-Ku antibody test was positive. A muscle biopsy revealed inflammatory myopathy with rimmed vacuoles (RVs). [ncbi.nlm.nih.gov]

    Distinguishing RA from SSc can be difficult because arthralgia is a frequent symptom of both. We observed three cases of RA and SSc overlap. [ekjm.org]

    Therefore, it can be useful to evaluate CRP, RF, and anti-CCP antibody in SSc patients presenting with arthralgia or arthritis in order to diagnose possible RA-SSc overlap syndrome [3]. [jrd.or.kr]

    Her review of systems was unremarkable, with no chronic fatigue, anorexia, abdominal pain, arthralgias or other symptoms suggestive of autoimmune disorders. [healio.com]

    Patients with overlap syndromes usually present with nonspecific symptoms, including fatigue, arthralgia, myalgia, jaundice and pale stools. [japi.org]

  • Proximal Muscle Weakness

    Muscle strength testing notable for proximal muscle weakness in upper and lower extremities with strength intact distally. She had no sensory abnormalities in all modalities. [n.neurology.org]

    SSc patients with serum CK more than 2 times upper limit, myalgia, and proximal muscle weakness were analyzed for the presence of polymyositis with electromyography (EMG) and muscle biopsy. [arthritis-research.biomedcentral.com]

    Proximal and symmetrical muscle weakness of both upper and lower limbs. Rashes on the skin, loss of hair, inflammation of blood vessels, oral ulcer, and inflammation of the pericardium. Lupus nephritis and neuropsychiatric lupus. [icliniq.com]

  • Morning Stiffness

    Rhupus patients have symmetrical polyarthritis, which frequently affects tiny joints in the hands and is accompanied by morning stiffness lasting 45 minutes or more. A rheumatoid nodule in SLE is a risk factor for the development of rhupus. [icliniq.com]

    stiffness朝のこわばり n necrotizing angiitis壊死性血管炎 neovascularization新生血管形成 nodule小[結]節 nonsteroidal anti-inflammatory drugs (NSAIDs)非ステロイド性抗炎症剤 o oligosialia唾液減少[症] osteoarthritis (OA)変形性関節症 overlap syndrome重複(オーバーラップ)症候群〈膠原病の〉 p pancreas膵臓、膵 peak [expiratory [tokyo-med.ac.jp]

Workup

Metabolic workup documented elevated cerebrospinal fluid lactate. Initial genetic analyses excluded the three most common LHON mutations. Subsequently, Sanger sequencing of the entire mitochondrial DNA (mtDNA) genome was performed. [ncbi.nlm.nih.gov]

The workup for other causes of liver disease including hepatitis B, HIV, Wilson disease, and α-1-antitrypsin phenotype was negative, and there was no history of drug or alcohol use. An abdominal ultrasound showed normal liver size and echogenicity. [journals.lww.com]

We consulted with the department of pulmonary medicine and checked baseline workup including chest x-ray, chest CT, transthoracic echocardiogram (TTE) and arterial blood gas analysis (ABGA). [e-jsm.org]

Treatment Approach for the Asthma-COPDOverlap Syndrome In general, the principles of workup and treatment are similar for asthma, COPD, and the overlap syndrome. [hindawi.com]

In addition, it is worth emphasizing the important role of MTND mutation, especially the MT-ND5 gene in the diagnostic workup of patients presenting with MELAS/LS overlap syndrome. [frontiersin.org]

X-Ray

  • Esophageal Motility Disorder

    motility disorder(食道機能異常)、sclerodactyly(強指症)、telangiectasia(毛細血管拡張)〉 crystal arthritis結晶性関節炎 cyclosporineサイクロスポリン cytokineサイトカイン d deep venous thrombosis (DVT)深在静脈血栓症 dermatomyositis (DM)皮膚筋炎 diffuse scleroderma汎発(全身)強(硬)皮症 discoid lupus erythematosus [tokyo-med.ac.jp]

Treatment

Before treatment, HCV RNA was 36,100 IU/mL, with AST 124 U/L and ALT 171 U/L. She was a rapid responder to the treatment with undetectable HCV RNA after 4 weeks of treatment (Fig. 2). She completed 48 weeks of antiviral treatment and achieved SVR. [journals.lww.com]

Andrew Schorr: …for treatment. Dr. Daver: …we had the Jakafi for treatment. [patientpower.info]

Currently, the most effective treatment for ACOS is unknown and omalizumab for ACOS has not yet been reported. We report our experience with anti-IgE, omalizumab treatment on 3 patients with ACOS as a retrospective case study. [ncbi.nlm.nih.gov]

Many questions remain, however, with regard to disease definition, prognosis, and optimal treatment. Treatment currently consists of continuous positive airway pressure, and oxygen as needed. [rc.rcjournal.com]

Prognosis

Patients with antisynthetase syndrome are generally considered to have a poor prognosis, with mortality 3 times greater than that of myositis without antisynthetase syndrome. [online.epocrates.com]

Interstitial pneumonia is a common and major comorbidity affecting the prognosis of patients with systemic sclerosis (SSc). However, there are few reported cases of SSc-rheumatoid arthritis (RA) overlap-associated interstitial pneumonia. [ncbi.nlm.nih.gov]

This is a necessary starting point from which to design studies to investigate the clinical features, aetiology, pathophysiology and prognosis of these patients, and ultimately determine treatment strategies. [um.edu.mt]

Etiology

While the etiology of connective tissue diseases remains unknown, the classification of individual cases will continue to depend on identifying certain patterns of clinical and laboratory features. [ncbi.nlm.nih.gov]

Current Opinion in Rheumatology. 3(6):995–1000, DEC 1991 PMID: 1772755 Issn Print: 1040-8711 Publication Date: 1991/12/01 Checking for direct PDF access through Ovid Abstract While the etiology of connective tissue diseases remains unknown, the classification [doi.org]

Later, etiologies included prion, autoimmune disease, and various toxic etiologies ( Antelmi et al 2015 ). The content you are trying to view is available only to logged in, current MedLink Neurology subscribers. [medlink.com]

This study required both untreated OHS (BMI≥30kg/m2, PaCO2≥45mmHg, pH≥7.35, and no alternative etiology of hypoventilation) and severe OSA (AHI≥30events/h) for enrollment. [archbronconeumol.org]

Epidemiology

Epidemiology and survival of systemic sclerosis-systemic lupus erythematosus overlap syndrome [published online July 15, 2018]. J Rheumatol. doi:10.3899/jrheum.170953 [rheumatologyadvisor.com]

Our primary aim was to identify prevalence and predictors of the overlap syndrome in Koreans.This is a cross-sectional study with a community-based sample of 1298 participants (mean age, 59.7 ± 6.7) from the cohort of Korean Genomic and Epidemiologic [ncbi.nlm.nih.gov]

This is a cross-sectional study with a community-based sample of 1298 participants (mean age, 59.7 ± 6.7) from the cohort of Korean Genomic and Epidemiologic Study during 2013 to 2014. [insights.ovid.com]

DISCUSSION In our study, we evaluated the epidemiology of SSc-SLE overlap compared to SSc. [jrheum.org]

Pathophysiology

We report 3 cases of patients with COPD in a stable clinical condition, referred to the Department of Respiratory Pathophysiology at the "Mariano Santo" Hospital in Cosenza, due to possible symptoms suggestive of obstructive sleep apnea, and who were [ncbi.nlm.nih.gov]

This is a necessary starting point from which to design studies to investigate the clinical features, aetiology, pathophysiology and prognosis of these patients, and ultimately determine treatment strategies. [um.edu.mt]

It is acknowledged that within this description of ACOS will lie a number of phenotypes that may in due course be identified by more detailed characterization on the basis of clinical, pathophysiological and genetic identifiers. [goldcopd.org]

Prevention

CPAP alone may not fully correct hypercapnia or hypoxemia, so non-invasive ventilation (NIV) treatment and/or supplemental oxygen may increase the clinical benefit to the patient. 18 NIV therapy can theoretically rest overloaded respiratory muscles, prevent [resmed.com]

A perceptive diagnostic approach toward these diseases is critical, and early diagnosis and treatment are needed to prevent dystrophic calcinosis. [ncbi.nlm.nih.gov]

Keep reading: 5 diet tips for people with COPD » As far as researchers know, there is no way to prevent asthma, but you can lower your risk of developing COPD. It’s unclear if lowering your risk of COPD also lowers your risk of developing ACOS. [healthline.com]

COPD is defined by the Global Initiative for Chronic Obstructive Lung disease (GOLD) as: A preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. [sleepapnea.org]

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