Dr.SIVADARSHAN MURALIDHARAN
Overlap syndrome is an entity that satisfies the criteria of at least two connective tissue diseases (CTD) namely Systemic Sclerosis, Rheumatoid Arthritis, Systemic Lupus Erythematosus, Dermatomyositis and Sjogren’s syndrome. A combined pathology has impact on the clinical features, diagnosis and treatment. We report a 19 year old girl with complaints of BE transient visual obscuration, fever, cough, difficulty breathing since 15 days. She was thin built, anemic and bilateral basal crepts was heard. Malar rash, induration, hyperpigmentation of limbs, sclerodactyly with fixed flexion deformities in fingers noted. Ocular examination was normal. ESR elevated, ANA, Anti ds DNA, Anti Sm antibody positive. Serum PTH and calcium was low, TSH elevated. Diagnosed as Scleroderma/ SLE overlap with Rheumatoid Arthritis. SLE rarely occurs with Scleroderma. Novel biological therapies may be used in these patients to avoid the hazardous influences of high-dose steroids, especially renal crisis.
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