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Overlap Syndrome - Symptoms, Associated Conditions, and Their Management

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Overlap syndromes are inflammatory rheumatic disorders in which individuals exhibit clinical symptoms of different immunological diseases.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At August 12, 2022
Reviewed AtJune 23, 2023

What Is Overlap Syndrome?

Overlap syndrome is also called polyarteritis nodosa and Churg-Strauss syndrome. About 60 % of patients with overlap syndrome develop peripheral neuropathy. Resemble polyneuropathy as more nerves are affected and deficits are coming together.

Mixed connective tissue disease (MCTD), where anti-small nuclear ribonucleoprotein (snRNP, or RNP) antibodies exist along with symptoms of at least two of the following: lupus, myositis, rheumatoid arthritis, and/or scleroderma, is a relatively typical example of an overlap syndrome. The categorization criteria for any or all of the underlying illnesses need not be met by patients with overlap syndromes. The patient may also have rheumatic overlap syndrome if they have an unexplained connective tissue disease (UCTD) and they do not fit the categorization criteria for any other disorder.

What Are the Symptoms of Overlap Syndrome?

  • Hypesthesia: Reduced sensitivity to stimuli.

  • Secondary Polyneuropathy: Nerve damage caused by taking a specific medicine or combination of medicines.

  • Plexopathy: A condition of the brachial or lumbosacral plexus nerve network.

  • Radiculopathy: A nerve root disease caused by a pinched nerve or a tumor.

How Can You Identify the Involvement of the Central Nervous System (CNS) In the Overlap Syndrome?

  • Headache: Aseptic meningitis.

  • Behavioral Disturbances: Cognitive decline, acute confusion, and affective or psychotic disorders.

Sudden cerebral infarction or hemorrhage → focal CNS deficit.

Extradural hematomas → ischemic or compressive myelopathies.

What Is What Is Overlap Syndrome With Systemic Lupus Erythematosus?

A group of diseases arising from a combination of loss of tolerance to self-antigens and shifting of the immune system into self-destructive overdrive is commonly classified under six mutually exclusive diseases. Such as:

  • Systemic Lupus Erythematosus (SLE): A chronic inflammatory condition that can damage several organs. Fever, exhaustion, joint discomfort, weakness, and rashes on the upper body, including the face and neck, are the symptoms.

  • Systemic Sclerosis (SSC): Diffuse widespread fibrosis and vascular anomalies in the skin, joints, and internal organs are the hallmarks of this uncommon, chronic disease (especially the upper and lower gastrointestinal tract, lungs, heart, and kidneys).

  • Dermatomyositis: A rare form of inflammation characterized by skin rashes and muscle weakness. Both adults and kids might be impacted by the illness.

  • Polymyositis: Inflammation of the muscles.

  • Rheumatoid Arthritis (RA): Autoimmune and inflammatory conditions occur when your immune system unintentionally targets healthy cells in your body, resulting in painful inflammation in the body areas affected. RA primarily targets joints, typically a number of joints at once.

  • Primary Sjögren Syndrome: an autoimmune disorder in which the lacrimal and salivary glands are invaded by lymphocytes, causing keratoconjunctivitis sicca (dry eyes) and xerostomia (dry mouth).

SLE can overlap with any other autoimmune diseases mentioned above.

Overlap Syndrome With Systemic Lupus Erythematosus

What Is Rhupus?

RA+SLE= Rhupus

Rhupus, an RA-SLE overlap syndrome, occurs in 0.01 % to 2 % of all SLE cases. The diagnosis of RA precedes the diagnosis of SLE in the majority of cases (83 %) of rhupus syndrome, with a median period of 7.8 years, while in the other instances, SLE either precedes RA with a median duration of 6.5 years or appears simultaneously with RA.

What Are the Symptoms of Rhupus?

  • 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.

  • Rhupus individuals have less lupus disease activity and a lower frequency of major organ involvement and damage compared to SLE.

  • Malar rash, autoimmune hemolytic anemia, neuropsychiatric lupus, and lupus nephritis are all less common in rhupus patients.

  • When compared to isolated SLE, rhupus patients exhibit greater levels of C-reactive protein and erythrocyte sedimentation rate.

How Can You Manage Rhupus?

  • Patient counseling.

  • Physical therapy.

  • Steroids with conventional disease-modifying Antirheumatic drugs (DMARDs) are given.

  • When DMARDs are ineffective, Cyclosporine or Mycophenolate mofetil can be advised.

  • Rituximab and Abatacept are found to be more effective.

What Is Lupoderma?

It is the overlap of SLE and SSC. The most common manifestation of this disease is Raynaud’s disease, calcinosis cutis, telangiectasias, Scleroderma renal crisis (SRC), ulcers in the fingertips, and interstitial lung disease (ILD). Polyserositis, inflammation of the pancreas, and necrosis of the bone due to lack of blood supply are also found most commonly in lupoderm.

What Are the Symptoms of SLE and Myositis Overlap?

  • 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.

How Does Managing SLE and Myositis Overlap?

  • Similar to the management of inflammatory myositis.

  • Most of the patients respond well to glucocorticoids.

  • DMARD and steroids are the alternatives to glucocorticoids.

  • In the cases of major organ involvement, immunosuppressants will be required.

  • For refractory mucositis with SLE, second-line immunosuppressants can be given.

What Is Polymyositis Scleroderma Overlap Syndrome?

Patients with overlapping features between polymyositis and systemic sclerosis are considered to have polymyositis overlap syndrome. The symptoms are gradually developing proximal muscle weakness, Raynaud phenomenon, and dysphagia. Patients should be closely monitored for pulmonary and cardiac decompensation. Steroids are the main course of treatment for this syndrome.

What Conditions Have Frequent Overlap With Irritable Bowel Syndrome?

Irritable bowel syndrome (IBS) is a multi-symptom gastrointestinal motility disorder with a wide clinical spectrum.

  • Symptom Overlap and Comorbidity Between IBS and Other Gastrointestinal Motility Disorders: Chronic constipation, functional dyspepsia, and gastroesophageal reflux disease.

  • Gastrointestinal Disorders Not Related to Motility: Celiac disease and lactose intolerance.

  • Somatic Conditions: Fibromyalgia and chronic fatigue syndrome.

What Is Asthma COPD Syndrome?

When the patients suffer from the symptoms of both asthma and COPD, they are diagnosed to have asthma COPD syndrome. Difficulty in breathing, excess mucus, feeling tired and frequent coughing, shortness of breath, and wheezing are the symptoms of this syndrome. Steroids and bronchodilators are the main treatment options preferred for this syndrome.

Conclusion:

An overlap syndrome is a medical condition that has characteristics of at least two other conditions. Many medical disciplines have overlap syndromes, such as overlapping connective tissue illnesses in rheumatology and overlapping genetic abnormalities in cardiology. Though the symptoms overlap, their management remains the same in most of the conditions.

Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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