Overlap Syndrome and Exogenous Asthma in Clinical Practice

Regarding overlap syndrome and exogenous asthma?

Hello, Doctor Gao.
I have been experiencing joint pain and low white blood cell counts for a long time.
However, since these symptoms fluctuate between severe and mild, and I usually feel better after taking painkillers and resting, I haven't paid much attention to them.
Recently, I started experiencing chest pain and shortness of breath, which prompted me to seek medical attention.
After compiling some past test results and recent examinations from the hospital, it turns out that I meet the diagnostic criteria for both rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).
To my surprise, I also have asthma triggered by allergens.
I am feeling very frustrated...
I would like to know how common it is in clinical practice to have multiple types of autoimmune diseases simultaneously.
After receiving treatment, is there a chance that I could stop taking medication in the future? Thank you very much.

Xiao Mi, 40~49 year old female. Ask Date: 2013/07/04

Dr. Gao Jiankai reply Internal Medicine

Hello, in clinical practice, it is quite rare for patients to meet the diagnostic criteria for both rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), especially since the pathogenic mechanisms of RA and SLE differ significantly.
Therefore, co-occurrence of these two diseases is generally uncommon.
However, there are exceptions in medical practice, and such cases do exist, albeit infrequently.
Treatment will focus on the more severe condition and carefully select medications that are effective for both diseases, which can lead to improvement in the patient's condition.

Regarding asthma, it is a relatively common condition compared to autoimmune diseases, so it may coexist with them.
Fortunately, medications used to control RA and SLE are also effective for asthma, which may simplify the types of medications needed.
It is advisable to discuss this with your physician.

Dealing with illness can be frustrating, especially when multiple conditions require long-term medication.
However, with regular treatment and careful monitoring, some patients can experience significant improvement, and there is even a possibility of managing their conditions with minimal or no medication.
Therefore, I encourage you to maintain an optimistic outlook.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2013/07/04

More Info

Overlap syndrome, particularly in the context of autoimmune diseases like rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), refers to the coexistence of features from multiple autoimmune disorders in a single patient. This phenomenon, while not exceedingly common, does occur in clinical practice and can pose significant diagnostic and therapeutic challenges.

In your case, the presence of joint pain and leukopenia (low white blood cell count) are symptoms that can be associated with both RA and SLE. The fact that you have now developed chest pain and asthma-like symptoms adds another layer of complexity, especially since asthma can be triggered by various allergens and may coexist with autoimmune conditions. The overlap of these conditions can lead to a more complicated clinical picture, as the treatment for one condition may influence the other.

Regarding the prevalence of overlap syndromes, while it is relatively rare to find patients who meet the diagnostic criteria for both RA and SLE simultaneously, it is not unheard of. The mechanisms underlying these diseases are different, with RA primarily affecting the joints and SLE being a more systemic disease that can impact multiple organ systems. However, the immune dysregulation that characterizes autoimmune diseases can lead to overlapping symptoms and conditions in some patients.
As for your concerns about treatment and the possibility of stopping medication in the future, it is essential to understand that the management of autoimmune diseases often requires a long-term commitment to therapy. The goal of treatment is to control symptoms, reduce inflammation, and prevent damage to affected organs. In some cases, patients may achieve remission or significant improvement in their condition, allowing for a reduction in medication or even discontinuation under careful medical supervision. However, this is highly individualized and depends on the severity of the disease, the response to treatment, and the presence of any complications.

In your situation, it is crucial to work closely with your healthcare provider to monitor your symptoms and adjust your treatment plan as necessary. The use of disease-modifying antirheumatic drugs (DMARDs) for RA and immunosuppressants for SLE can be effective in managing these conditions. Additionally, medications for asthma, such as inhaled corticosteroids or bronchodilators, may be necessary to control your respiratory symptoms.

It is also important to maintain a proactive approach to your health. Regular follow-ups with your rheumatologist and possibly an allergist or pulmonologist for your asthma can help ensure that all aspects of your health are being addressed. Lifestyle modifications, such as stress management, a balanced diet, and regular exercise, can also play a significant role in managing autoimmune diseases and improving overall well-being.

In summary, while the coexistence of RA, SLE, and asthma is complex, it is manageable with a comprehensive treatment plan tailored to your specific needs. Open communication with your healthcare team, adherence to prescribed therapies, and regular monitoring will be key to navigating your health journey. Stay optimistic, as many patients with similar conditions can achieve significant improvements in their quality of life with appropriate care.

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