'Overlap' syndromes

Article Abstract:

The concept of overlap syndromes began to be used in rheumatology clinics as a way to describe groups of symptoms resembling those of one or more autoimmune diseases (in which the body makes antibodies against its own tissues), but where the symptoms did not completely fulfill the accepted criteria for distinct entities such as rheumatoid arthritis or systemic lupus erythematosus. In several cases, these overlap syndromes have become somewhat better defined because blood tests reveal the presence of a specific antibody in those syndromes. Mixed connective tissue disease is associated with an antibody to a particular RNA (ribonucleic acid) protein, but symptoms may resemble those of pulmonary, kidney, or brain disease. Often the symptoms of this disease shift towards those of progressive systemic sclerosis (scleroderma), with concomitant loss of the RNA-protein antibodies. Subacute cutaneous lupus erythematosus is associated with marked skin lesions, arthritis, and heart complications in the patient and in offspring, as well. Antiphospholipid syndrome has been proposed as a term for patients who develop antibodies to phospholipids, which form the membranes surrounding all body cells. These patients frequently develop thrombosis (clotting), recurrent miscarriages, and low levels of platelets, plus heart or other complications. Although originally associated with lupus or lupus-like diseases, it is now recognized as independent of systemic lupus erythematosus. Many but not all of these patients often go on to develop other connective tissue disorder such as systemic lupus erythematosus. The occurrence of these overlap entities varies a great deal from hospital to hospital for several reasons. Although treatment programs have been developed for each of these syndromes, prognosis is still unclear. The syndromes may be better termed transitional rather than overlap, until more precise medical classifications of the syndromes are available. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Autoimmune diseases, Terminology, Diagnosis, Differential, Differential diagnosis

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Thrombocytopenia in the antiphospholipid syndrome

Article Abstract:

Disease characteristics among patients with the antiphospholipid syndrome (APS) who have low platelet counts do not seem to differ from patients with APS who have normal platelet counts. Platelet counts and disease characteristics were compared among 171 patients with APS. Twenty-three percent of these patients had low platelet counts. APS characteristics were similar irrespective of platelet count. However, 13 patients with low platelet counts miscarried their pregnancies and had blood clots. Patients with low platelet counts tended to have consistently positive tests for antibodies to antiphospholipids.

Causes of, Complications and side effects, Antiphospholipid syndrome, Thrombocytopenia

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Immunosuppressive treatment in severe connective tissue diseases: effects of low dose intravenous cyclophosphamide

Article Abstract:

Low-dose cyclophosphamide treatment appears to provide similar benefit as the more concentrated treatment for patients with severe connective tissue diseases. Laboratory measures of disease progression among 90 patients with various connective tissue diseases were compared before and 56 months after a median of three weeks of the low-dose treatment. Seventy-five percent of the patients went into remission during the study period. Laboratory values significantly improved in patients with systemic lupus erythematosus and vasculitis. Menstrual periods were uninterrupted in treated women of childbearing age.

Evaluation, Drug therapy, Connective tissue diseases, Cyclophosphamide

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