Abstract
A 37 year-old woman with overlapping syndrome of dermatomyositis (DM) and rheumatoid Arthritis (RA) visited to my office as having RA. At the first visit, as 10 mg of prednisolone/day, 1000 mg of salazosulfapirizin/day and 6 mg of methotrexate/week were already being administrated, treatment of RA begun. As the first blood examination showed positive rheumatoid factor and the abnormality of liver function, we added 2 mg of folic acid considering the side effects of MTX.
After that, increased enzymes derived from muscle were found. 4 months later, she was admitted to Oita Red Cross Hospital because muscle enzymes had increased much. That blood examination revealed that anti-nuclear antibody and anti-Jo1 antibody were positive. Finally, she was diagnosed with overlapping syndrome with RA and DM. The case of simultaneous onset of RA and DM usually goes through a serious clinical course with lung fibrosis. However, this case was treated with a small dose of PSL (30 mg/day) and 1.5 mg of Tascrorims, resulting in easier remission without lung fibrosis.
Since the first visit to my office, she was presented Gottoron’s sign, Heliotrope rash, and poikiloderma retrospectively.
Preconception for RA induced the misjudgment of the right diagnosis. The wrong diagnosis was made partly because the anti-nuclear antibody was not examined at the first medical examination.
When there are doubts about RA in the first medical examination, it is necessary to examine the antinuclear antibodies from the first visit.
