<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1817-5996</journal-id>
<journal-title><![CDATA[Revista Cubana de Reumatología]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Cuba Reumatol]]></abbrev-journal-title>
<issn>1817-5996</issn>
<publisher>
<publisher-name><![CDATA[Editorial CIMEQ]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1817-59962019000400004</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Síndrome de solapamiento: polimiositis-esclerodermia. Presentación de un caso]]></article-title>
<article-title xml:lang="en"><![CDATA[Polymyosis-Sclerosis Overlap Syndrome. Case report and review of literature]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fonseca Muñoz]]></surname>
<given-names><![CDATA[Rocío Beatriz]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González-Costa]]></surname>
<given-names><![CDATA[Maricarmen]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Padrón González]]></surname>
<given-names><![CDATA[Alexander Ariel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Ciencias Médicas "Mariana Grajales" de Holguín Hospital Clínico Quirúrgico de Holguín "Lucía Íñiguez Landín" ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Cuba</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de Ciencias Médicas de La Habana Instituto de Ciencias Básicas y Preclínicas: "Victoria de Girón" ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Cuba</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2019</year>
</pub-date>
<volume>21</volume>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_arttext&amp;pid=S1817-59962019000400004&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_abstract&amp;pid=S1817-59962019000400004&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_pdf&amp;pid=S1817-59962019000400004&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción:  en el síndrome de solapamiento o superposición existen simultáneamente manifestaciones clínicas o serológicas de dos o más enfermedades autoinmunes sistémicas. Afectan al 5 % de la población con predominio en mujeres.  Presentación del Caso:  hombre de 48 años, sin antecedentes patológicos personales. Acude con dolor en ambas manos, inflamación en las articulaciones metacarpo e interfalángicas proximales, bilateral y simétrica, acompañada de rigidez matinal que duraba casi todo el día desde hace 4 meses. Se le diagnostica artritis reumatoidea y se inicia tratamiento que abandonó. Luego aparece un cuadro que es interpretado como un solapamiento por lo que es ingresado con un cuadro clínico florido. En los exámenes de laboratorio: las transaminasas, la creatín fosfoquinasa, el lactato deshidrogenasa, se encontraban elevadas. Por la clínica y los complementarios se diagnosticó Síndrome de Solapamiento de polimiosistis-esclerodermia. Se comenzó tratamiento con inmunosupesores. El paciente evolucionó desfavorablemente y falleció.  Discusión: el diagnóstico de este caso se realizó por las manifestaciones clínicas como fascie esclerodérmica, signo de sal y pimienta, fibrosis de predominio distal en ambas manos, telangiectasias peribucales. Los diagnósticos diferenciales son las enfermedades autoinmunes sistémicas cuando se presentan como cuadros únicos. El tratamiento de primera línea y el pronóstico dependen de las enfermedades que se solapen.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction:  In the syndrome of overlap or overlap there are simultaneously clinical or serological manifestations of two or more systemic autoimmune diseases. They affect 5% of the population with predominance in women.  Case Presentation:  A 48-year-old man with no personal pathological history. He came with pain in both hands, inflammation in the metacarpal and interphalangeal proximal joints, bilateral and symmetrical, accompanied by morning stiffness that lasted almost all day for 4 months. He was diagnosed with rheumatoid arthritis and started treatment that he abandoned. Then a picture appears that is interpreted as an overlap so it is entered with a florid clinical picture. In laboratory tests: transaminases, creatine phosphokinase, lactate dehydrogenase, were elevated. Clinical and complementary diagnosis of Polymyosis-Sclerosis Overlap Syndrome was diagnosed. Treatment with immunosupers was started. The patient evolved unfavorably and died.  Discussion:  The diagnosis of this case was made by clinical manifestations such as sclerodermic fascia, salt and pepper sign, predominantly distal fibrosis in both hands, perioral telangiectasias. Differential diagnoses are systemic autoimmune diseases when presented as single frames. First-line treatment and prognosis depend on overlapping diseases.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[síndrome de solapamiento]]></kwd>
<kwd lng="es"><![CDATA[síndrome de superposición]]></kwd>
<kwd lng="es"><![CDATA[polimiositis]]></kwd>
<kwd lng="es"><![CDATA[esclerodermia]]></kwd>
<kwd lng="en"><![CDATA[overlapping syndrome]]></kwd>
<kwd lng="en"><![CDATA[superposition syndrome]]></kwd>
<kwd lng="en"><![CDATA[polymyositis]]></kwd>
<kwd lng="en"><![CDATA[scleroderma]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Duró Pujol]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
</person-group>
<source><![CDATA[Reumatología clínica]]></source>
<year>2010</year>
<publisher-loc><![CDATA[Barcelona ]]></publisher-loc>
<publisher-name><![CDATA[Ed. Elsevier]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rojas]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Anaya]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Cano]]></surname>
<given-names><![CDATA[LE]]></given-names>
</name>
<name>
<surname><![CDATA[Aristizábal]]></surname>
<given-names><![CDATA[BH]]></given-names>
</name>
<name>
<surname><![CDATA[Gómez]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
<name>
<surname><![CDATA[Lopera]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<source><![CDATA[Inmunología de Rojas]]></source>
<year>2015</year>
<edition>17ma</edition>
<page-range>465-74</page-range><publisher-loc><![CDATA[Medellín ]]></publisher-loc>
<publisher-name><![CDATA[Ed. Fondo CIB]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Jury]]></surname>
<given-names><![CDATA[EC]]></given-names>
</name>
<name>
<surname><![CDATA[D'Cruz]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[W Morrow]]></surname>
<given-names><![CDATA[WJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Autoantibodies and overlap syndromes in autoimmune rheumatic disease]]></article-title>
<source><![CDATA[Group Ltd &amp; Association of Clinical Pathologists]]></source>
<year>2017</year>
</nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sharp]]></surname>
<given-names><![CDATA[GC]]></given-names>
</name>
<name>
<surname><![CDATA[Irwin]]></surname>
<given-names><![CDATA[WS]]></given-names>
</name>
<name>
<surname><![CDATA[Tan]]></surname>
<given-names><![CDATA[EM]]></given-names>
</name>
<name>
<surname><![CDATA[Gould]]></surname>
<given-names><![CDATA[RG]]></given-names>
</name>
<name>
<surname><![CDATA[Holman]]></surname>
<given-names><![CDATA[HR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Mixed connective tissue disease: an apparently distinct rheumatic disease syndrome associated with a specific antibody to an extractable nuclear antigen (ENA)]]></article-title>
<source><![CDATA[Am J Med]]></source>
<year>2015</year>
<volume>1972</volume>
<numero>52</numero>
<issue>52</issue>
<page-range>148-59</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lockshin]]></surname>
<given-names><![CDATA[MD]]></given-names>
</name>
<name>
<surname><![CDATA[Levine]]></surname>
<given-names><![CDATA[AB]]></given-names>
</name>
<name>
<surname><![CDATA[Erkan]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Patients with overlap autoimmune disease differ from those with 'pure' disease]]></article-title>
<source><![CDATA[Lupus Sci Med]]></source>
<year>2015</year>
<volume>2</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Moinzadeh]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Aberer]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Ahmadi-Simab]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Blank]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[W Distler]]></surname>
<given-names><![CDATA[JH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Disease progression in systemic sclerosis-overlap syndrome is significantly different from limited and diffuse cutaneous systemic sclerosis]]></article-title>
<source><![CDATA[Ann Rheum Dis]]></source>
<year>2015</year>
<volume>74</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>730-7</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Alba Fériz]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Muñoz Louis]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Espinoza]]></surname>
<given-names><![CDATA[LR]]></given-names>
</name>
<name>
<surname><![CDATA[Khamashta]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Matucci]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Sanmartí]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<source><![CDATA[Enfermedades Inflamatorias Reumatológicas. Panamerican League of Associations for Rheumatology]]></source>
<year>2016</year>
<publisher-loc><![CDATA[N. York ]]></publisher-loc>
<publisher-name><![CDATA[Ed. Producciones Científica Ltda PANLAR]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Alarcón-Segovia]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Molina]]></surname>
<given-names><![CDATA[LJ]]></given-names>
</name>
</person-group>
<source><![CDATA[Tratado hispanoamericano de Reumatología]]></source>
<year>2007</year>
<publisher-loc><![CDATA[Bogotá ]]></publisher-loc>
<publisher-name><![CDATA[Ed. Nomos]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Larrauri Blas]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Fernández Romero]]></surname>
<given-names><![CDATA[DS]]></given-names>
</name>
<name>
<surname><![CDATA[Juri]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
<name>
<surname><![CDATA[Malbrán]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Miopatías inflamatorias con evolución recidivante]]></article-title>
<source><![CDATA[Medicina (B. Aires)]]></source>
<year>2016</year>
<volume>76</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>379-82</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cappelli S]]></surname>
<given-names><![CDATA[Bellando-Randone S]]></given-names>
</name>
<name>
<surname><![CDATA[Guiducci S]]></surname>
<given-names><![CDATA[Matucci-Cerinic]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Is Immunossuppressive therapy the anchor treatment to achieve remission in systemic sclerosis?]]></article-title>
<source><![CDATA[Rheumatology Oxford]]></source>
<year>2014</year>
<volume>53</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>975-87</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pakozdi]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Nihtyanova]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Moinzadeh]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Clinical and serological hallmarks of systemic sclerosis overlap syndromes]]></article-title>
<source><![CDATA[J Rheumatol]]></source>
<year>2011</year>
<volume>38</volume>
<page-range>2406-9</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
