Pope Janet E
Department of Medicine, Division of Rheumatology, University of Western Ontario, London, Canada.
Curr Opin Rheumatol. 2002 Nov;14(6):704-10. doi: 10.1097/00002281-200211000-00013.
Scleroderma is a connective tissue disease that causes fibrosis and vascular abnormalities, but that also has an autoimmune component. Many patients with scleroderma have a positive antinuclear antibody, and there can be family histories of other connective tissue diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis. Some patients have features of scleroderma and other autoimmune conditions. This article will review recent literature to help in the understanding of scleroderma with overlap features. Recent reports of scleroderma overlap with rheumatoid arthritis suggest distinct features of diffuse scleroderma with positive Scl-70, pulmonary fibrosis, and later seropositive erosive rheumatoid arthritis. SLE rarely occurs with scleroderma. Sjögren syndrome symptoms are common in scleroderma. In primary Sjögren syndrome, anticentromere antibody positive patients have more Raynaud phenomenon. Antibodies that occur in scleroderma that are thought to be specific are present in other connective tissue diseases. For instance, Scl-70 antibody is reported in as many as 35% of patients with scleroderma but can be present in 25% of patients with SLE. Myositis or myopathy can be features of scleroderma. Scleroderma overlap with polymyositis is frequently anti-PM Scl antibody positive, whereas anti-Jo-1 does not normally occur in the overlap of scleroderma and polymyositis but is usually exclusively positive in polymyositis with arthritis and alveolitis. A better prognosis is found with PM Scl antibody in myositis. Vasculitis is not a typical feature of scleroderma, but has been reported. Eosinophilic fasciitis is rare, and the onset could be associated with simvastatin.
硬皮病是一种结缔组织疾病，可导致纤维化和血管异常，但其也有自身免疫成分。许多硬皮病患者抗核抗体呈阳性，并且可能有其他结缔组织疾病的家族史，如系统性红斑狼疮（SLE）和类风湿关节炎。一些患者同时具有硬皮病和其他自身免疫性疾病的特征。本文将回顾近期文献，以帮助理解具有重叠特征的硬皮病。近期关于硬皮病与类风湿关节炎重叠的报道显示，弥漫性硬皮病具有不同特征，包括Scl - 70阳性、肺纤维化，以及后期血清阳性侵蚀性类风湿关节炎。SLE很少与硬皮病同时发生。干燥综合征症状在硬皮病中很常见。在原发性干燥综合征中，抗着丝点抗体阳性的患者雷诺现象更多。硬皮病中出现的被认为具有特异性的抗体也存在于其他结缔组织疾病中。例如，据报道多达35%的硬皮病患者有Scl - 70抗体，但25%的SLE患者也可能有该抗体。肌炎或肌病可能是硬皮病的特征。硬皮病与多发性肌炎重叠时通常抗PM Scl抗体呈阳性，而抗Jo - 1通常不会出现在硬皮病与多发性肌炎的重叠情况中，而是通常仅在伴有关节炎和肺泡炎的多发性肌炎中呈阳性。肌炎患者中PM Scl抗体阳性预后较好。血管炎不是硬皮病的典型特征，但已有相关报道。嗜酸性筋膜炎罕见，其发病可能与辛伐他汀有关。
