Antisynthetase syndrome complicating the course of established case with rheumatoid arthritis: A rare and under-recognized overlapping disease

Emad, Yasser; Ragab, Yasser; Abdelsalam, Mostafa; Rasker, Johannes J.

doi:10.1016/j.reuma.2018.06.002

Cited by 6 publications

(9 citation statements)

References 13 publications

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“…When a patient presents with joint involvement, the pattern is a peripheral symmetric polyarthritis, similar to that of rheumatoid arthritis (19). The patient may also present with rheumatoid factor, anti-cyclic citrullinated peptide (anti-CCP) autoantibodies, and bone erosions that may be correlated with anti-CCP positivity (19,20). When patients have isolated joint symptoms, it is difficult for rheumatologists to think about ASS.…”

Section: Original Papermentioning

confidence: 99%

The clinical manifestations at the onset of antisynthetase syndrome: A chameleon with multiple faces

et al. 2020

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The antisynthetase syndrome (ASS) is clinically characterized by fever, myositis, interstitial lung disease, joint involvement, mechanic’s hands, or Raynaud’s phenomenon, and the presence of antisynthetase autoantibodies. These clinical manifestations may not occur simultaneously. Therefore, the aim of this study was to analyze the sequence in which these clinical manifestations can develop at the onset of ASS. This retrospective, single-center cohort study enrolled 55 ASS patients. Their mean age at the onset of ASS symptoms was 42.3±11.8 years. There was a predominance of female patients (75.9%) and white patients (72.7%). At initial presentation, 41.8% of the patients had fever, 43.6% had joint symptoms, 38.2% had myositis, 36.4% had interstitial lung disease, 18.2% had Raynaud’s phenomenon, and 16.4% had mechanic’s hands. Subsequent clinical symptoms emerged at varying time points. In two out of 55 cases, joint, muscle, and lung manifestations developed simultaneously. The median time between the onset of symptoms and the complete ASS clinical manifestation was 19.9 (4.0-60.2) months; whereas, the timeframe between the onset of symptoms and the ASS diagnosis was 29.0 (11.0-63.0) months. The confounding misdiagnoses interfering with the initial diagnosis were polymyositis (52.7%), dermatomyositis (29.1%), nonspecific interstitial pneumopathy (23.6%), rheumatoid arthritis (18.2%), and others (10.9%). Clinical features at the onset of ASS are highly variable. Consequently, confounding factors can lead to significant delays for the final and definitive diagnosis of ASS. Therefore, ASS should be considered a differential diagnosis in patients with initial symptoms of joint, lung, and/or muscle involvements, as well as fever, mechanic’s hands, and/or Raynaud’s phenomenon manifestations.

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Section: Original Papermentioning

confidence: 99%

The clinical manifestations at the onset of antisynthetase syndrome: A chameleon with multiple faces

et al. 2020

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“…Clinically, the inflammatory arthritis of ASyS has been confused with rheumatoid arthritis [10,[18][19][20][21]. As described in one cohort, patients with early arthritis typically presented with a symmetric polyarthritis, and a later presentation of these symptoms was more likely to be oligoarticular or asymmetric [2].…”

Section: Discussionmentioning

confidence: 99%

Sonographic findings from inflammatory arthritis due to antisynthetase syndrome

et al. 2019

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Objective: Inflammatory arthritis is a common feature of the antisynthetase syndrome. Ultrasonography is able to characterize important features of bone and tendon pathology but has not been evaluated in this setting. We review the sonographic findings in a series of patients with antisynthetase syndrome and inflammatory arthritis. Methods: A retrospective chart review was performed of patients with antisynthetase syndromeassociated inflammatory arthritis who had undergone ultrasound imaging for joint pathology. Results: Seventeen sonographic assessments of eight patients were included. Synovial hypertrophy was seen in all eight patients, with active Doppler signal present in six patients (13 of 17 ultrasound locations). Tendon involvement was common, with tenosynovitis in seven patients (11 of 17 ultrasound locations). Erosions were present in five patients. Conclusion: Musculoskeletal ultrasound showed significant joint pathology including proliferative synovitis and tenosynovitis. This may be severe and associate with erosive disease. Further systematic studies are needed to better understand the articular involvement of antisynthetase syndrome.

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“…In this report, we describe the case of a rare association of SNRA with ASS. Overlap between RA and ASS has only been reported previously in a few case reports[ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Pulmonary hypertension secondary to seronegative rheumatoid arthritis overlapping antisynthetase syndrome: A case report

Huang¹,

Lu²,

Tian³

et al. 2022

WJCC

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BACKGROUND Polyarthritis is the most frequent clinical manifestation in antisynthetase syndrome (ASS) forms of idiopathic inflammatory myositis and may be misdiagnosed as rheumatoid arthritis (RA), particularly in patients with seronegative RA (SNRA). It is unclear whether there is an overlap between ASS and RA, or if ASS sometimes mimics RA. Pulmonary hypertension (PAH) is common in connective tissue diseases (CTDs). However, published reports on CTD-PAH do not include overlapping CTDs, and its incidence and impact on patient prognosis are unclear. CASE SUMMARY We report the case of a 63-year-old woman who presented with a 3-mo history of symptom aggravation of recurrent symmetrical joint swelling and pain that had persisted for over 10 years. The patient was diagnosed with RA and interstitial lung disease. The patient repeatedly presented to the hospital’s respiratory and rheumatology departments with arthralgia, plus shortness of breath after activity. Relevant tests indicated that anti-CCP and RF remained negative, while anti-J0-1 and anti-Ro-52 were strongly positive. It was not until recently that we recognized that this could be an unusual case of SNRA with concurrent ASS. Joint pain was relieved after regular anti-rheumatic treatment. Chest computed tomography scans showed that pulmonary interstitial changes did not progress significantly over several years; however, they showed gradual widening of the pulmonary artery, and cardiac ultrasound indicated elevated pulmonary artery systolic pressure. The prescribed treatment of PAH was not effective in improving shortness of breath. CONCLUSION Overlap of RA and ASS may be missed. Further research is necessary to facilitate early diagnosis, effective evaluation, and prognosis.

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Antisynthetase syndrome complicating the course of established case with rheumatoid arthritis: A rare and under-recognized overlapping disease

Cited by 6 publications

References 13 publications

The clinical manifestations at the onset of antisynthetase syndrome: A chameleon with multiple faces

The clinical manifestations at the onset of antisynthetase syndrome: A chameleon with multiple faces

Sonographic findings from inflammatory arthritis due to antisynthetase syndrome

Pulmonary hypertension secondary to seronegative rheumatoid arthritis overlapping antisynthetase syndrome: A case report

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