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Síndromes de sobreposição

最后审阅: 20 Aug 2025
最后更新: 14 Nov 2023

小结

定义

病史和体格检查

关键诊断因素

  • presença de fatores de risco
  • palidez/dor nos dedos
  • artrite/artralgia
  • mãos edemaciadas
  • esclerodactilia
  • alterações vasculares na dobra ungueal
  • dispneia ou tosse
  • doença do refluxo gastroesofágico (DRGE) e pirose
  • mialgias ou miosite
完整详情

其他诊断因素

  • hematúria
  • linfadenopatia
  • alopécia
  • rashes cutâneos
  • fraqueza muscular proximal
  • neuralgia do trigêmeo
  • cefaleias
  • doença neuropsiquiátrica inclusive psicose e convulsões
  • neuropatia periférica
  • febre
完整详情

危险因素

  • sexo feminino
  • idade de 20 a 40 anos
  • presença de genótipos específicos do antígeno leucocitário humano (HLA)
完整详情

诊断性检查

首要检查

  • Hemograma completo
  • velocidade de hemossedimentação
  • proteína C-reativa
  • ureia e creatinina séricas
  • fator reumatoide
  • fator antinuclear
  • anticorpo antipeptídeo citrulinado cíclico (anti-CCP)
  • urinálise
  • anti-ribonucleoproteína U1
  • anti-Jo-1
完整详情

需考虑的检查

  • creatina quinase
  • anti-DNA de fita dupla
  • antígeno de Smith
  • anti-SS-A e anti-SS-B
  • testes de anticorpos adicionais (anti-Scl 70, anticorpos anticentrômero, anti-RNA polimerase III, anticorpos anti-PM/Scl)
  • testes de função pulmonar (espirometria, volumes pulmonares e medição da capacidade de difusão)
  • radiografia torácica
  • TC de alta resolução do tórax
  • ecocardiograma
  • cateterismo cardíaco direito
  • esofagografia baritada
  • endoscopia digestiva alta ± biópsia
  • radiografia simples da(s) articulação(ões) afetada(s)
  • eletromiografia
  • estudos da condução nervosa
  • biópsia muscular
  • biópsia pulmonar
  • biópsia renal
完整详情

新兴检查

  • anticorpos anti-Ku
  • outros anticorpos antissintetase (PL7, PL12, JO, EJ, KS, Ha e outros)

治疗流程

持续性治疗

todos os pacientes

撰稿人

作者

Larry Young, MD

Associate Professor of Medicine

Division of Rheumatology

Miller School of Medicine

University of Miami

Miami

FL

利益声明

LY declares that he has no competing interests.

Carlos Lozada, MD

Associate Professor of Medicine

Division of Rheumatology and Immunology

Miller School of Medicine

University of Miami

Miami

FL

利益声明

CL declares that he has no competing interests.

鸣谢

Dr Larry Young and Dr Carlos Lozada would like to gratefully acknowledge Dr Robert Hoffman, a previous contributor to this topic.

利益声明

RH has received NIH grants greater than 6 figures USD. RH is the author of some studies referenced in this topic. RH declares that he has no competing interests.

同行评议者

Robert Ortmann, MD

Associate Professor and Director

Division of Rheumatology and Immunology

University of Arkansas for Medical Sciences

Little Rock

AR

利益声明

RO declares that he has no competing interests.

Alan Bridges, MD

Professor and Vice Chair

Department of Medicine

University of Wisconsin Hospital

Madison

WI

Disclosures

AB declares that he has no competing interests.

Simon Bowman, PhD, FRCP

Consultant Rheumatologist and Honorary Senior Clinical Lecturer in Rheumatology

Selly Oak Hospital

Birmingham

UK

Disclosures

SB declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Ungprasert P, Crowson CS, Chowdhary VR, et al. Epidemiology of mixed connective tissue disease, 1985-2014: a population-based study. Arthritis Care Res (Hoboken). 2016 Dec;68(12):1843-8.Full text  Abstract

Hoffman Robert W. 152 - Overlap syndromes. In: Hochberg Marc C, Silman Alan J, Smolen Josef S. et al., eds. Rheumatology. 6th ed. Maryland Heights, MO: Mosby; 2015, 1264-9.​

Kasukawa R, Tojo T, Miyawaki S, et al. Preliminary diagnostic criteria for classification of mixed connective tissue disease. In: Kasukawa R, Sharp GC, eds. Mixed connective tissue disease and anti-nuclear antibodies. Amsterdam, the Netherlands: Elsevier; 1987:41-7.

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Differentials

    • Lúpus eritematoso sistêmico (LES)
    • Polimiosite
    • Esclerodermia
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  • Guidelines

    • 2022 Guideline for vaccinations in patients with rheumatic and musculoskeletal diseases
    More Guidelines
  • Patient information

    Refluxo gastroesofágico, pirose e doença do refluxo gastroesofágico (DRGE)

    Artrite reumatoide

    More Patient information
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