Yan Rui, Ke Dan, Zhang Yan, Li Li, Liu Yanying, Li Shengguang, Liu Xiaomin
Department of Rheumatology and Immunology, Beijing Shunyi Hospital, Beijing, China.
Department of Rheumatology and Immunology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Front Immunol. 2025 Aug 8;16:1626226. doi: 10.3389/fimmu.2025.1626226. eCollection 2025.
The coexistence of psoriatic arthritis (PsA) with inflammatory myopathies, including antisynthetase syndrome (ASS), is exceptionally rare and presents significant diagnostic and therapeutic challenges. This study reports a case of PsA overlapping with ASS and reviews the literature to analyze clinical features, immunopathogenesis, and treatment strategies.
A 52-year-old female with a 10-year history of psoriasis developed PsA and later presented with muscle weakness, mechanic's hands, and interstitial lung disease (ILD). Serological testing revealed anti-Jo-1 and anti-SSA/Ro52 positivity, confirming ASS. We compare our case with 17 previously reported cases of psoriasis or PsA coexisting with inflammatory myopathies, highlighting similarities and differences in clinical presentation and treatment response.
Psoriasis and inflammatory myopathies share immunopathogenic pathways, including the IL-17/IL-23 axis, type I interferons, and TNF-α. Therapies effective for psoriasis/PsA, such as TNF and IL-17 inhibitors, may exacerbate inflammatory myopathies, while JAK inhibitors and corticosteroids appear more effective in managing overlap cases. Our patient achieved sustained remission with baricitinib and low-dose prednisone after multiple treatment adjustments.
PsA and inflammatory myopathies can coexist, requiring careful differentiation and tailored immunomodulatory therapy. Clinicians should recognize overlapping features and optimize treatment to prevent exacerbations. Further research is needed to establish standardized management strategies for this rare overlap syndrome.
银屑病关节炎（PsA）与包括抗合成酶综合征（ASS）在内的炎性肌病并存极为罕见，带来了重大的诊断和治疗挑战。本研究报告一例PsA与ASS重叠的病例，并回顾文献以分析临床特征、免疫发病机制及治疗策略。
一名有10年银屑病病史的52岁女性患了PsA，随后出现肌肉无力、技工手和间质性肺病（ILD）。血清学检测显示抗Jo-1和抗SSA/Ro52阳性，确诊为ASS。我们将我们的病例与之前报道的17例银屑病或PsA与炎性肌病并存的病例进行比较，突出临床表现和治疗反应的异同。
银屑病和炎性肌病共享免疫发病途径，包括IL-17/IL-23轴、I型干扰素和TNF-α。对银屑病/PsA有效的疗法，如TNF和IL-17抑制剂，可能会加重炎性肌病，而JAK抑制剂和皮质类固醇在处理重叠病例时似乎更有效。我们的患者在多次调整治疗后，使用巴瑞替尼和低剂量泼尼松实现了持续缓解。
PsA和炎性肌病可并存，需要仔细鉴别并进行针对性的免疫调节治疗。临床医生应认识到重叠特征并优化治疗以防止病情加重。需要进一步研究以建立针对这种罕见重叠综合征的标准化管理策略。
