Skip to main content

Advertisement

SpringerLink
Log in

Overlap Syndromes in Inflammatory Myopathies

  • Other CTD: Inflammatory Myopathies and Sjogren's (P Basharat, Section Editor)
  • Published:
Current Treatment Options in Rheumatology Aims and scope Submit manuscript

Opinion statement

Purpose of Review This review discusses the epidemiology, evaluation and treatment of overlap inflammatory myopathy syndromes.

Recent findings Evaluation of overlap myopathy in systemic sclerosis (SSc) has shown that the disease is often heterogeneous with variable presentation, histopathology, and response to therapy. These differences have shown to be important in management, specifically with the response to immunosuppression. Inflammation and necrosis are features suggestive of a positive response, whereas fibrosis and neurogenic atrophy are also common and may be less responsive to therapy.

Summary Inflammatory myopathy associated with overlap connective tissue disease is often associated with greater morbidity, and there are few studies to guide treatment. Treatment is often tailored to the patient based on severity of muscular and concomitant extramuscular disease. While further research is needed to better understand treatment of overlap syndromes, the absence of consensus criteria remains a limiting factor.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Recently published papers of particular interest have been highlighted as: • Of importance •• Of major importance

  1. Váncsa A, Gergely L, Ponyi A, et al. Myositis-specific and myositis-associated antibodies in overlap myositis in comparison to primary dermatopolymyositis: relevance for clinical classification: retrospective study of 169 patients. Jt Bone Spine Rev Rhum. 2010;77(2):125–30.

    Article  Google Scholar 

  2. Leclair V, Regardt M, Wojcik S, et al. Health-related quality of life (HRQoL) in idiopathic inflammatory myopathy: a systematic review. PLoS One. 2016;11(8):e0160753.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Feldon M, Farhadi PN, Brunner HI, et al. Predictors of reduced health-related quality of life in adult patients with idiopathic inflammatory myopathies. Arthritis Care Res. 2017; https://doi.org/10.1002/acr.23198.

  4. Regardt M, Welin Henriksson E, Sandqvist J, et al. Work ability in patients with polymyositis and dermatomyositis: an explorative and descriptive study. Work. 2015;53(2):265–77.

    Article  PubMed  Google Scholar 

  5. Bradford Rice J, White A, Lopez A, et al. Healthcare resource utilization and work loss in dermatomyositis and polymyositis patients in a privately-insured US population. J Med Econ. 2016;19(7):649–54.

    Article  CAS  PubMed  Google Scholar 

  6. Paik JJ, Wigley FM, Mejia AF, et al. Independent association of severity of muscle weakness with disability as measured by the health assessment questionnaire disability index in scleroderma. Arthritis Care Res (Hoboken). 2016;68(11):1695–703.

    Article  Google Scholar 

  7. Paik JJ. Myopathy in scleroderma and in other connective tissue diseases. Curr Opin Rheumatol. 2016;28(6):631–5.

    Article  CAS  PubMed  Google Scholar 

  8. West SG, Killian PJ, Lawless OJ. Association of myositis and myocarditis in progressive systemic sclerosis. Arthritis Rheum. 1981;24(5):662–8.

    Article  CAS  PubMed  Google Scholar 

  9. Medsger TA, Rodnan GP, Moossy J, et al. Skeletal muscle involvement in progressive systemic sclerosis (scleroderma). Arthritis Rheum. 1968;11(4):554–68.

    Article  PubMed  Google Scholar 

  10. Clements PJ, Furst DE, Campion DS, et al. Muscle disease in progressive systemic sclerosis: diagnostic and therapeutic considerations. Arthritis Rheum. 1978;21(1):62–71.

    Article  CAS  PubMed  Google Scholar 

  11. Mimori T. Scleroderma-polymyositis overlap syndrome. clinical and serologic aspects. Int J Dermatol. 1987;26(7):419–25.

    Article  CAS  PubMed  Google Scholar 

  12. Garcin B, Lenglet T, Dubourg O, et al. Dropped head syndrome as a presenting sign of scleromyositis. J Neurol Sci. 2010;292(1–2):101–3.

    Article  PubMed  Google Scholar 

  13. Jung M, Bonner A, Hudson M, et al. Myopathy is a poor prognostic feature in systemic sclerosis: results from the Canadian Scleroderma Research Group (CSRG) cohort. Scand J Rheumatol. 2014;43(3):217–20.

    Article  CAS  PubMed  Google Scholar 

  14. Bhansing KJ, Lammens M, Knaapen HK, et al. Scleroderma-polymyositis overlap syndrome versus idiopathic polymyositis and systemic sclerosis: a descriptive study on clinical features and myopathology. Arthritis Res Ther. 2014;16(3):R111.

    Article  PubMed  PubMed Central  Google Scholar 

  15. • Ranque B, Authier FJ, Le-Guern V, et al. A descriptive and prognostic study of systemic sclerosis-associated myopathies. Ann Rheum Dis. 2009;68(9):1474–7. This study suggests that the response to immunosuppression is related to presence of inflammation on biopsy

    Article  CAS  PubMed  Google Scholar 

  16. Paik JJ, Wigley FM, Shah AA, et al. Fibrosing myopathy in systemic sclerosis associates with higher mortality. Arthritis Care Res (Hoboken). 2017; https://doi.org/10.1002/acr.23291.

  17. Toledano C, Gain M, Kettaneh A, et al. Aldolase predicts subsequent myopathy occurrence in systemic sclerosis. Arthritis Res Ther. 2012;14(3):R152.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Steen VD. Autoantibodies in systemic sclerosis. Semin Arthritis Rheum. 2005;35(1):35–42.

    Article  CAS  PubMed  Google Scholar 

  19. Bell S, Krieg T, Meurer M. Antibodies to Ro/SSA detected by ELISA: correlation with clinical features in systemic scleroderma. Br J Dermatol. 1989;121(1):35–41.

    Article  CAS  PubMed  Google Scholar 

  20. Koschik RW, Fertig N, Lucas MR, et al. Anti-PM-Scl antibody in patients with systemic sclerosis. Clin Exp Rheumatol. 2012;30(2 Suppl 71):S12–6.

    PubMed  Google Scholar 

  21. Vandergheynst F, Ocmant A, Sordet C, et al. Anti-pm/scl antibodies in connective tissue disease: clinical and biological assessment of 14 patients. Clin Exp Rheumatol. 2006;24(2):129–33.

    CAS  PubMed  Google Scholar 

  22. •• Paik JJ, Wigley FM, Lloyd TE, et al. Spectrum of muscle histopathologic findings in forty-two scleroderma patients with weakness. Arthritis Care Res (Hoboken). 2015;67(10):1416–25. This study provides histopathologic findings in patients with scleroderma and weakness showing the high prevalence of neurogic atrophy and fibrosis

    Article  Google Scholar 

  23. Schanz S, Henes J, Ulmer A, et al. Magnetic resonance imaging findings in patients with systemic scleroderma and musculoskeletal symptoms. Eur Radiol. 2013;23(1):212–21.

    Article  PubMed  Google Scholar 

  24. Ranque B, Authier FJ, Berezne A, et al. Systemic sclerosis-associated myopathy. Ann N Y Acad Sci. 2007;1108:268–82.

    Article  CAS  PubMed  Google Scholar 

  25. Steen VD, Medsger TA. Case-control study of corticosteroids and other drugs that either precipitate or protect from the development of scleroderma renal crisis. Arthritis Rheum. 1998;41(9):1613–9.

    Article  CAS  PubMed  Google Scholar 

  26. Guillevin L, Berezne A, Seror R, et al. Scleroderma renal crisis: a retrospective multicentre study on 91 patients and 427 controls. Rheumatology (Oxford). 2012;51(3):460–7.

    Article  CAS  Google Scholar 

  27. Ruperto N, Pistorio A, Oliveira S, et al. Prednisone versus prednisone plus ciclosporin versus prednisone plus methotrexate in new-onset juvenile dermatomyositis: a randomised trial. Lancet. 2016;387(10019):671–8.

    Article  PubMed  Google Scholar 

  28. Vencovský J, Jarosova K, Machacek S, et al. Cyclosporine A versus methotrexate in the treatment of polymyositis and dermatomyositis. Scand J Rheumatol. 2000;29(2):95–102.

    Article  PubMed  Google Scholar 

  29. Ibrahim F, Choy E, Gordon P, et al. Second-line agents in myositis: 1-year factorial trial of additional immunosuppression in patients who have partially responded to steroids. Rheumatology (Oxford). 2015;54(6):1050–5.

    Article  CAS  Google Scholar 

  30. Majithia V, Harisdangkul V. Mycophenolate mofetil (CellCept): an alternative therapy for autoimmune inflammatory myopathy. Rheumatology (Oxford). 2005;44(3):386–9.

    Article  CAS  Google Scholar 

  31. Mendoza FA, Nagle SJ, Lee JB, et al. A prospective observational study of mycophenolate mofetil treatment in progressive diffuse cutaneous systemic sclerosis of recent onset. J Rheumatol. 2012;39(6):1241–7.

    Article  CAS  PubMed  Google Scholar 

  32. Liossis SN, Bounas A, Andonopoulos AP. Mycophenolate mofetil as first-line treatment improves clinically evident early scleroderma lung disease. Rheumatology (Oxford). 2006;45(8):1005–8.

    Article  CAS  Google Scholar 

  33. Dalakas MC, Illa I, Dambrosia JM, et al. A controlled trial of high-dose intravenous immune globulin infusions as treatment for dermatomyositis. N Engl J Med. 1993;329(27):1993–2000.

    Article  CAS  PubMed  Google Scholar 

  34. Cherin P, Pelletier S, Teixeria A, et al. Results and long-term followup of intravenous immunoglobulin infusions in chronic, refractory polymyositis: an open study with thirty-five adult patients. Arthritis Rheum. 2002;46(2):467–74.

    Article  CAS  PubMed  Google Scholar 

  35. Saito E, Koike T, Hashimoto H, et al. Efficacy of high-dose intravenous immunoglobulin therapy in Japanese patients with steroid-resistant polymyositis and dermatomyositis. Mod Rheumatol. 2008;18(1):34–44.

    Article  CAS  PubMed  Google Scholar 

  36. Pisoni CN, Cuadrado MJ, Khamashta MA, et al. Mycophenolate mofetil treatment in resistant myositis. Rheumatology (Oxford). 2007;46(3):516–8.

    Article  CAS  Google Scholar 

  37. Abelha-Aleixo J, Bernardo A, Costa L. Benefit of intravenous immunoglobulin in a patient with longstanding polymyositis/systemic sclerosis overlap syndrome. Acta Reumatol Port. 2015;40(2):176–8.

    CAS  PubMed  Google Scholar 

  38. Mauhin W, Rivière S, Cabane J, et al. Improvement in lung fibrosis using intravenous immunoglobulin in systemic sclerosis with myositis. Scand J Rheumatol. 2014;43(2):170–1.

    Article  CAS  PubMed  Google Scholar 

  39. Poelman CL, Hummers LK, Wigley FM, et al. Intravenous immunoglobulin may be an effective therapy for refractory, active diffuse cutaneous systemic sclerosis. J Rheumatol. 2015;42(2):236–42.

    Article  CAS  PubMed  Google Scholar 

  40. Vilela VS, Maretti GB, Gama LM, et al. Rituximab for the therapy of systemic sclerosis: a series of 10 cases in a single center. Rev Bras Reumatol Engl Ed. 2016;56(5):458–63.

    Article  PubMed  Google Scholar 

  41. Fabri M, Hunzelmann N, Krieg T, et al. Discordant response to rituximab in a systemic sclerosis patient with associated myositis. J Am Acad Dermatol. 2008;58(5 Suppl 1):S127–8.

    Article  PubMed  Google Scholar 

  42. Kondo M, Murakawa Y, Matsumura T, et al. A case of overlap syndrome successfully treated with tocilizumab: a hopeful treatment strategy for refractory dermatomyositis. Rheumatology (Oxford). 2014;53(10):1907–8.

    Article  CAS  Google Scholar 

  43. Elhai M, Meunier M, Matucci-Cerinic M, et al. Outcomes of patients with systemic sclerosis-associated polyarthritis and myopathy treated with tocilizumab or abatacept: a EUSTAR observational study. Ann Rheum Dis. 2013;72(7):1217–20.

    Article  CAS  PubMed  Google Scholar 

  44. Miró O, Pedrol E, Casademont J, et al. Muscle involvement in rheumatoid arthritis: clinicopathological study of 21 symptomatic cases. Semin Arthritis Rheum. 1996;25(6):421–8.

    Article  PubMed  Google Scholar 

  45. Labrador-Horrillo M, Martinez MA, Selva-O’Callaghan A, et al. Anti-cyclic citrullinated peptide and anti-keratin antibodies in patients with idiopathic inflammatory myopathy. Rheumatology (Oxford). 2009;48(6):676–9.

    Article  CAS  Google Scholar 

  46. • Aguila LA, Lopes MR, Pretti FZ, et al. Clinical and laboratory features of overlap syndromes of idiopathic inflammatory myopathies associated with systemic lupus erythematosus, systemic sclerosis, or rheumatoid arthritis. Clin Rheumatol. 2014;33(8):1093–8. This study reviews features associated with overlap syndromes

    Article  PubMed  Google Scholar 

  47. Ancuţa C, Pomirleanu DC, Anton CR, et al. Rheumatoid myositis, myth or reality? A clinical, imaging and histological study. Romanian J Morphol Embryol. 2014;55(3):781–5.

    Google Scholar 

  48. Nakajima A, Yoshino K, Soejima M, et al. High frequencies and co-existing of myositis-specific autoantibodies in patients with idiopathic inflammatory myopathies overlapped to rheumatoid arthritis. Rheumatol Int. 2012;32(7):2057–61.

    Article  CAS  PubMed  Google Scholar 

  49. Halla JT, Koopman WJ, Fallahi S, et al. Rheumatoid myositis. Clinical and histologic features and possible pathogenesis. Arthritis Rheum. 1984;27(7):737–43.

    Article  CAS  PubMed  Google Scholar 

  50. Cavagna L, Fusetti C, Montecucco C, et al. Anticyclic citrullinated peptide antibodies as markers of erosive arthritis in antisynthetase syndrome. J Rheumatol. 2010;37(9):1967.

    Article  PubMed  Google Scholar 

  51. Schmidt WA, Wetzel W, Friedlander R, et al. Clinical and serological aspects of patients with anti-Jo-1 antibodies—an evolving spectrum of disease manifestations. Clin Rheumatol. 2000;19(5):371–7.

    Article  CAS  PubMed  Google Scholar 

  52. Lefèvre G, Meyer A, Launay D, et al. Seronegative polyarthritis revealing antisynthetase syndrome: a multicentre study of 40 patients. Rheumatology (Oxford). 2015;54(5):927–32.

    Article  Google Scholar 

  53. Nagashima T, Sato H, Minota S. Destructive arthropathy associated with dermatomyositis sine myositis positive for anti-Jo-1 and anti-cyclic citrullinated peptide antibodies. J Rheumatol. 2009;36(9):2133–4.

    Article  PubMed  Google Scholar 

  54. Meyer A, Lefevre G, Bierry G, et al. In antisynthetase syndrome, ACPA are associated with severe and erosive arthritis: an overlapping rheumatoid arthritis and antisynthetase syndrome. Medicine (Baltimore). 2015;94(20):e523.

    Article  CAS  Google Scholar 

  55. Brunasso AM, Aberer W, Massone C. New onset of dermatomyositis/polymyositis during anti-TNF-α therapies: a systematic literature review. ScientificWorldJournal. 2014;2014:179180.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Rojas-Serrano J, Herrera-Bringas D, Perez-Roman DI, et al. Rheumatoid arthritis-related interstitial lung disease (RA-ILD): methotrexate and the severity of lung disease are associated to prognosis. Clin Rheumatol. 2017;36(7):1493–500.

    Article  PubMed  Google Scholar 

  57. Parziale N, Kovacs SC, Thomas CB, et al. Rituximab and mycophenolate combination therapy in refractory dermatomyositis with multiple autoimmune disorders. J Clin Neuromuscul Dis. 2011;13(2):63–7.

    Article  PubMed  Google Scholar 

  58. Aggarwal R, Bandos A, Reed AM. Predictors of clinical improvement in rituximab-treated refractory adult and juvenile dermatomyositis and adult polymyositis. Arthritis Rheumatol. 2014;66(3):740–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Oddis CV, Reed AM, Aggarwal R, et al. Rituximab in the treatment of refractory adult and juvenile dermatomyositis and adult polymyositis: a randomized, placebo-phase trial. Arthritis Rheum. 2013;65(2):314–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Andersson H, Sem M, Lund MB, et al. Long-term experience with rituximab in anti-synthetase syndrome-related interstitial lung disease. Rheumatology (Oxford). 2015;54(8):1420–8.

    Article  CAS  Google Scholar 

  61. Marie I, Dominique S, Janvresse A, et al. Rituximab therapy for refractory interstitial lung disease related to antisynthetase syndrome. Respir Med. 2012;106(4):581–7.

    Article  CAS  PubMed  Google Scholar 

  62. Dayal NA, Isenberg DA. SLE/myositis overlap: are the manifestations of SLE different in overlap disease? Lupus. 2002;11(5):293–8.

    Article  CAS  PubMed  Google Scholar 

  63. Liang Y, Leng RX, Pan HF, et al. Associated variables of myositis in systemic lupus erythematosus: a cross-sectional study. Med Sci Monit. 2017;23:2543–9.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Tsokos GC, Moutsopoulos HM, Steinberg AD. Muscle involvement in systemic lupus erythematosus. JAMA. 1981;246(7):766–8.

    Article  CAS  PubMed  Google Scholar 

  65. Jakati S, Rajesekhar L, Uppin M, et al. SLE myopathy: a clinicopathological study. Int J Rheum Dis. 2015;18(8):886–91.

    Article  PubMed  Google Scholar 

  66. Torrente-Segarra V, Salman-Monte TC, Rua-Fiueroa I, et al. Fibromyalgia prevalence and related factors in a large registry of patients with systemic lupus erythematosus. Clin Exp Rheumatol. 2016;34(2 Suppl 96):S40–7.

    PubMed  Google Scholar 

  67. Lim KL, Abdul-Wahab R, Lowe J, et al. Muscle biopsy abnormalities in systemic lupus erythematosus: correlation with clinical and laboratory parameters. Ann Rheum Dis. 1994;53(3):178–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Nakaya I, Iwata Y, Sugiyama Y, et al. Dermatomyositis relapse complicated with gastric carcinoma and lupus nephritis five years after the initial diagnosis of dermatomyositis. Intern Med. 2002;41(6):502–3.

    Article  PubMed  Google Scholar 

  69. Kijima T, Kanekiyo S, Nakasuga C, et al. A case report of a patient with overlap syndrome systemic lupus erythematosus (SLE) and polymyositis (PM) whose condition improved following treatment for coexisting descending colon cancer. Gan To Kagaku Ryoho. 2013;40(12):1936–8.

    PubMed  Google Scholar 

  70. Mascaró JM, Ferrando J, Sole MT, et al. Paraneoplastic pemphigus: a case of long-term survival associated with systemic lupus erythematosus and polymyositis. Dermatology. 1999;199(1):63–6.

    Article  PubMed  Google Scholar 

  71. Tselios K, Gladman DD, Su J, et al. Antimalarials as a risk factor for elevated muscle enzymes in systemic lupus erythematosus. Lupus. 2016;25(5):532–5.

    Article  CAS  PubMed  Google Scholar 

  72. Maazoun F, Frikha F, Snoussi M, et al. Systemic lupus erythematosusmyositis overlap syndrome: report of 6 cases. Clin Pract. 2011;1(4):e89.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Wenzel J, Uerlich M, Gerdsen R, et al. Association of inclusion body myositis with subacute cutaneous lupus erythematosus. Rheumatol Int. 2001;21(2):75–7.

    Article  CAS  PubMed  Google Scholar 

  74. Limaye V, Scott G, Kwiatek R, et al. Inclusion body myositis associated with systemic lupus erythematosus (SLE). Aust NZ J Med. 2000;30(2):275–6.

    Article  CAS  Google Scholar 

  75. Varela-Rosario N, Pérez-Berenguer JL, Vilá LM. Efficacy of immunosuppressive treatment in a systemic lupus erythematosus patient presenting with inclusion body myositis. BMJ Case Rep. 2016;5:2016.

    Google Scholar 

  76. Stein M, Bell MJ, Ang LC. Hydroxychloroquine neuromyotoxicity. J Rheumatol. 2000;27(12):2927–31.

    CAS  PubMed  Google Scholar 

  77. Meesiri S. Pyomyositis in a patient with systemic lupus erythaematosus and a review of the literature. BMJ Case Rep. 2016;2016:10.

  78. Ravindran V, Duke O. Non-tropical pyomyositis in a patient with systemic lupus erythematosus. Lupus. 2009;18(4):379–80.

    Article  CAS  PubMed  Google Scholar 

  79. Garton MJ, Isenberg DA. Clinical features of lupus myositis versus idiopathic myositis: a review of 30 cases. Br J Rheumatol. 1997;36(10):1067–74.

    Article  CAS  PubMed  Google Scholar 

  80. Bunch TW, Worthington JW, Combs JJ, et al. Azathioprine with prednisone for polymyositis. A controlled, clinical trial. Ann Intern Med. 1980;92(3):365–9.

    Article  CAS  PubMed  Google Scholar 

  81. Bunch TW. Prednisone and azathioprine for polymyositis: long-term followup. Arthritis Rheum. 1981;24(1):45–8.

    Article  CAS  PubMed  Google Scholar 

  82. S L, Tony K, Raghupathy, et al. A rare case of mixed connective tissue disease (mctd) with intricate features of lupus, polymyositis and rheumatoid arthritis presenting with severe myositis. J Clin Diagn Res. 2015;9(3):OD05–7.

    PubMed  PubMed Central  Google Scholar 

  83. Wise CM, Vuyyuru S, Roberst WN. Methotrexate in nonrenal lupus and undifferentiated connective tissue disease—a review of 36 patients. J Rheumatol. 1996;23(6):1005–10.

    CAS  PubMed  Google Scholar 

  84. Hashimoto M, Nonaka S, Furuta E, et al. Methotrexate for steroid-resistant systemic lupus erythematosus. Clin Rheumatol. 1994;13(2):280–3.

    CAS  PubMed  Google Scholar 

  85. Luzi G, Diamanti AP, Germano V, et al. Successful treatment with intravenous immunoglobulins in a patient affected by dermatomyositis/systemic lupus erythematosus overlap syndrome and tuberculosis. Clin Immunol. 2007;125(2):127–30.

    Article  CAS  PubMed  Google Scholar 

  86. Ramos-Casals M, Garcia-Hernandez FJ, de Ramon E, et al. Off-label use of rituximab in 196 patients with severe, refractory systemic autoimmune diseases. Clin Exp Rheumatol. 2010;28(4):468–76.

    CAS  PubMed  Google Scholar 

  87. Bang SY, Lee CK, Kang YM, et al. Multicenter retrospective analysis of the effectiveness and safety of rituximab in Korean patients with refractory systemic lupus erythematosus. Autoimmune Dis. 2012;2012:565039.

    PubMed  PubMed Central  Google Scholar 

  88. Aoki A, Ono S, Ueda A, et al. Myositis in primary Sjogren’s syndrome: clinical and pathological report. Mod Rheumatol. 2003;13(1):57–61.

    Article  CAS  PubMed  Google Scholar 

  89. Ramos-Casals M, Brito-Zeron P, Solans R, et al. Systemic involvement in primary Sjogren’s syndrome evaluated by the EULAR-SS disease activity index: analysis of 921 Spanish patients (GEA-SS Registry). Rheumatology (Oxford). 2014;53(2):321–31.

    Article  Google Scholar 

  90. Lindvall B, Bengtsson A, Ernerudh J, et al. Subclinical myositis is common in primary Sjogren’s syndrome and is not related to muscle pain. J Rheumatol. 2002;29(4):717–25.

    PubMed  Google Scholar 

  91. Colafrancesco S, Priori R, Gattamelata A, et al. Myositis in primary Sjogren’s syndrome: data from a multicentre cohort. Clin Exp Rheumatol. 2015;33(4):457–64.

    PubMed  Google Scholar 

  92. Fauchais AL, Martel C, Gondran G, et al. Immunogogical profile in primary Sjogren syndrome: clinical significance, prognosis and long-term evolution to other autoimmune disease. Autoimmun Rev. 2010;9(9):595–9.

    Article  CAS  PubMed  Google Scholar 

  93. Vrethem M, Lindvall B, Holmgren H, et al. Neuropathy and myopathy in primary Sjogren’s syndrome: neurophysiological, immunological and muscle biopsy results. Acta Neurol Scand. 1990;82(2):126–31.

    Article  CAS  PubMed  Google Scholar 

  94. Misterska-Skora M, Sebastian A, Dziegiel P, et al. Inclusion body myositis associated with Sjogren’s syndrome. Rheumatol Int. 2013;33(12):3083–6.

    Article  PubMed  Google Scholar 

  95. Espitia-Thibault A, Masseau A, Neel A, et al. Sjogren’s syndrome-associated myositis with germinal centre-like structures. Autoimmun Rev. 2017;16(2):154–8.

    Article  CAS  PubMed  Google Scholar 

  96. Mashaly R, Hauw JJ, Poisson M, et al. Polymyositis with infiltration by lymphoid follicles. Arch Neurol. 1981;38(12):777–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Mason F Lord Building Center Tower, Suite 4100, Baltimore, MD, 21224, USA

    John B. Miller MD & Julie J. Paik MD

Authors
  1. John B. Miller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julie J. Paik MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julie J. Paik MD.

Ethics declarations

Conflict of Interest

John Miller and Julie Paik declare they have no conflict of interest. This article does not contain any studies with human or animal subjects performed by any of the authors.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Other CTD: Inflammatory Myopathies and Sjogren's

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Miller, J.B., Paik, J.J. Overlap Syndromes in Inflammatory Myopathies. Curr Treat Options in Rheum 3, 289–298 (2017). https://doi.org/10.1007/s40674-017-0074-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40674-017-0074-y

Keywords

Search

Navigation