Evaluation of the Clinical Presentation, Treatment and Prognosis of Systemic Sclerosis and Systemic Lupus Erythematosus Overlap Patients

全身性硬化症重疊全身性紅斑性狼瘡的病人其臨床表現、治療成效及預後之評估

許惠晴(Hui-Ching Hsu) ； 吳政翰(Cheng-Han Wu) ； 謝松洲(Song-Chou Hsieh) ； 余家利(Chia-Li Yu)

《Formosan Journal of Rheumatology》 27卷1期 (2013/09) Pp. 54-63

https://doi.org/10.6313/FJR.2013.27(01).08

摘要

Objective: To analyze the clinical characteristics, laboratory findings, treatment and prognosis of systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) overlap patients in comparison to patients with SSc alone in a medical center in northern Taiwan, and to perform a literature review on this topic.Methods: We retrospectively examined the electronic medical records of all patients with SSc from December 2002 to November 2012. Patients fulfilling the classification criteria for both SSc and SLE were identified and compared to the SSc patients.Results: A total 57 SSc patients were collected; 33 (57.89%) in the SSc control group and 24 (42.11%) in the SSc overlap syndrome group. Of the 24 patients in the overlap group, 16 had SSc and SLE overlap syndrome (16/57, 28.07%). Elevated IgG, low C4, and positive antibody against dsDNA, histone, Jo1, RNP, SSA, SSB, or Sm were more common in the SSc and SLE overlap group compared to the SSc control group (p＜0.05). Multivariate logistic regression demonstrated that female gender and low C4 incurred an increased risk of an association with SSc and SLE overlap syndrome. Moreover, the SSc overlap patients had significant higher titers of anti-Scl 70 compared to the SSc controls (mean value: 365.4 vs. 339.5, p＜0.001), suggesting that overlap with SSc should be considered in SLE patients with higher titers of anti-Scl 70.Conclusion: Low C4, elevated IgG, positive anti-dsDNA antibody or positive antibody against various extractable nuclear antigen, and high titers of anti-Scl 70 antibody suggest SSc and SLE overlap syndrome.

關鍵字

全身性性硬化症 ； 全身性紅斑性狼瘡 ； 重疊症候群

並列摘要

Objective: To analyze the clinical characteristics, laboratory findings, treatment and prognosis of systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) overlap patients in comparison to patients with SSc alone in a medical center in northern Taiwan, and to perform a literature review on this topic.Methods: We retrospectively examined the electronic medical records of all patients with SSc from December 2002 to November 2012. Patients fulfilling the classification criteria for both SSc and SLE were identified and compared to the SSc patients.Results: A total 57 SSc patients were collected; 33 (57.89%) in the SSc control group and 24 (42.11%) in the SSc overlap syndrome group. Of the 24 patients in the overlap group, 16 had SSc and SLE overlap syndrome (16/57, 28.07%). Elevated IgG, low C4, and positive antibody against dsDNA, histone, Jo1, RNP, SSA, SSB, or Sm were more common in the SSc and SLE overlap group compared to the SSc control group (p＜0.05). Multivariate logistic regression demonstrated that female gender and low C4 incurred an increased risk of an association with SSc and SLE overlap syndrome. Moreover, the SSc overlap patients had significant higher titers of anti-Scl 70 compared to the SSc controls (mean value: 365.4 vs. 339.5, p＜0.001), suggesting that overlap with SSc should be considered in SLE patients with higher titers of anti-Scl 70.Conclusion: Low C4, elevated IgG, positive anti-dsDNA antibody or positive antibody against various extractable nuclear antigen, and high titers of anti-Scl 70 antibody suggest SSc and SLE overlap syndrome.

並列關鍵字

Systemic sclerosis ； systemic lupus erythematosus ； overlap syndrome