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]
- Excessive Daytime Sleepiness
Both surveys included questions on asthma, COPD, respiratory and sleep-related symptoms, including difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, and excessive daytime sleepiness. [ajmc.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]
- 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]
- Pallor
General physical examination revealed pallor. Systemic examination was normal. [e-ijd.org]
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]
- 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
- Hypertension
Pulmonary hypertension is the commonest disease-related cause of death in patients with MCTD. [online.epocrates.com]
August 02, 2018 Patients with SSc-SLE overlap syndrome were younger, had higher rates of pulmonary arterial hypertension, and less frequently had SSc cutaneous manifestations. [rheumatologyadvisor.com]
We found that SSc-SLE subjects more frequently had pulmonary hypertension. The frequency of pulmonary hypertension among SSc-SLE overlap subjects has been varied. [jrheum.org]
COPD patients have a 30-70 percent prevalence of pulmonary hypertension. However, patients with both COPD and OSA have an 86 percent prevalence of pulmonary hypertension. [sleepresolutions.com]
Patients with the overlap syndrome demonstrate greater degrees of oxygen desaturation predisposing to pulmonary hypertension, which is especially common in these patients. [mdedge.com]
- 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]
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]
Key Words: Systemic sclerosis; Rheumatoid arthritis 죟ě ě´: ě ě 경íěŚ; ëĽë§í°ě¤ ę´ě ěź TOOLS METRICS 0 Crossref 0 Scopus 2,929 View 29 Download [ekjm.org]
However, a recent arthritis flare was not controlled well, and radiographic joint damage was found on plain hand radiographs (Figure 2). [jrd.or.kr]
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]
- 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]
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]
Simultaneously, occurrence of painful intraoral (buccal mucosa, palate/tongue) ulcers, swelling of both hands, arthralgia/myalgia and listlessness, ocular (watering, burning, and reddening) complaints, and loss of hearing made her seek dermatological [e-ijd.org]
- Osteoporosis
Specific therapies for osteoporosis should be considered when the estimated risk of fracture is high. Initial fasting blood glucose and regular blood glucose levels are recommended in chronic corticosteroid treatment. [online.epocrates.com]
[…] collagen disease 甲状腺機能亢進症 hyperthyroidism 甲状腺機能低下症 hypothyroidism 甲状腺中毒症 thyrotoxicosis 後天性免疫不全症候群 acquired immune deficiency syndrome 高コレステロール血症 hypercholesterolemia 高トリグリセリド血症 hypertriglyceridemia 高リポ蛋白血症 hyperlipoproteinemia ゴーシェ病 Gaucher disease 骨粗鬆症 osteoporosis [jsge.or.jp]
Management of osteoporosis, fat soluble vitamin deficiencies and hyperlipidemia in primary biliary cirrhosis. Clin Liver Dis 2003;7:901-10. 76. Chazouilleres O, Wendum D, Serfaty L, Rosmorduc O, Poupon R. [saudijgastro.com]
The prevention of osteoporosis was achieved with regular supplementation of vitamin D and calcium, as well as with regular bone mineral density controls using densitometry. 4. [fortunejournals.com]
- 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]
Neurologic
- Seizure
A 5-year-old girl with cutis marmorata telangiectasia congenita (CMTC) and congenital glaucoma, who had previously presented with seizures, transient hemiplegia, upper gastrointestinal bleeding and hemihypertrophy, developed a large pleural effusion. [ncbi.nlm.nih.gov]
Here, we reported a case of overlap syndrome who presented with seizures and features of systemic lupus erythematosus, systemic sclerosis with the presence of strongly positive ANA, Anti snRNP, Anti Scl-70 antibody and weakly positive Anti Sm antibody [banglajol.info]
Considering clinical features in concordance with MELAS (5), the top three most common symptoms were seizures, cognitive impairment, and SLE in our cohort. [frontiersin.org]
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]
Other Pathologies
- Lymphocytic Infiltrate
Right side ( B, D, F ) : PM patient. ( A) Hematoxylin & eosin (H&E) stain; upper marker, necrosis; lower marker, lymphocytic infiltrate; (B) H&E stain; marker, lymphocytic infiltrate; (C) MAC stain; markers, MAC upregulation; (D) MAC stain, no upregulation [arthritis-research.biomedcentral.com]
Liver biopsy was done which revealed lymphocytic infiltrates, bile duct loss with proliferation and hepatocytes showed feathery degeneration, intrahepatic cholestasis and minimal regeneration. [japi.org]
Figure 2: (a) Follicular plugging, effaced rete ridges and mononuclear inflammatory infiltrate near the dermal-epidermal junction (H and E, ×100). (b) Lymphocytic infiltrate around the eccrine glands in the reticular dermis (H and E, ×400). [e-ijd.org]
アレルギー interstitial nephritis間質性腎炎 interstitial pneumonia間質性肺炎 intractable asthma難治性喘息 intracutaneous reaction皮内反応 j jerk fingerばね指、弾発指 l LE factorLE因子 LE phenomenonLE現象 leukocytosis白血球増加[症] lupus erythematosus (LE)エリテマトーデス、紅斑性狼瘡 lupus nephritisループス腎炎 lymphocytic [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]
Patients with overlap syndrome have a worse prognosis compared to those with either COPD or OSA alone. [eurekaselect.com]
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]
The purpose of this report is to describe the pathophysiology of COPD and OSA, as each disease process contributes uniquely to the development of OS. [eurekaselect.com]
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]