J Rheum Dis.  2013 Aug;20(4):251-255. 10.4078/jrd.2013.20.4.251.

A Case of Overlap Syndrome of Rheumatoid Arthritis and Polymyositis with the Involvement of Upper Pharyngeal Muscles

• Jang WS
• Kim SM
• Hong SJ
• Lee SH
• Song R
• Yang HI
• Lee YA

• KMID: 2297541
• DOI: http://doi.org/10.4078/jrd.2013.20.4.251

Abstract

An overlap syndrome is a combination of major features of more than one connective tissue diseases which is presented in the same patient. An overlap syndrome of rheumatoid arthritis (RA) and polymyositis (PM) which involved the upper pharyngeal muscle has not been reported in Korea. Herein, we report a rare case of a patient with a long-history RA presenting proximal muscle weakness and swallowing difficulty, who was successfully treated with a high-dose of corticosteroid, azathioprine and tacrolimus.

Keyword

Rheumatoid arthritis; Polymyositis; Overlap syndrome

MeSH Terms

Arthritis, Rheumatoid
Azathioprine
Connective Tissue Diseases
Deglutition
Humans
Korea
Muscle Weakness
Pharyngeal Muscles
Polymyositis
Tacrolimus
Azathioprine
Tacrolimus

Figure

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  Figure 1. Both hand radiographs show characteristic features of rheumatoid arthritis, including periarticular osteopenia, joint space narrowing and articular erosions of carpometacarpal, radiocarpal and intercarpal joints.

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  Figure 2. Radiographic changes typical of rheumatoid arthritis on anteroposterior foot X-ray. This revealed bony erosions with joint space narrowing of both metatarsophalangeal, intertarsal and tarsometatarsal joints.

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  Figure 3. Initial chest radiograph shows characteristic findings of a “tuberculosis-destroyed lung” (A). A chest computed tomography revealed interstitial lung disease at the basal portion of the right lower lobe (B).

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  Figure 4. Videofluoroscopic swallowing study shows barium liquid (5 ml) transfer with mild stasis in the esophageal phase.

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  Figure 5. Clinical course of the patient. Muscle strength was assessed by the physical examination.

Reference

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