Rare Case Highlights Diagnostic and Treatment Challenges in PsA–Myopathy Overlap

A newly reported case of psoriatic arthritis (PsA) overlapping with antisynthetase syndrome (ASyS ) underscores the need for heightened clinical vigilance and tailored treatment strategies when inflammatory myopathies co-occur with psoriatic disease. The case study, accompanied by a review of 17 similar reports, details shared immunopathogenesis and conflicting treatment responses in this rare overlap syndrome.

The patient, a 52-year-old woman with a 10-year history of psoriasis, developed PsA followed by progressive muscle weakness, mechanic’s hands, and interstitial lung disease (ILD). Positive anti-Jo-1 and anti-SSA/Ro52 antibodies confirmed a diagnosis of ASyS. The clinical trajectory required multiple therapeutic adjustments before achieving remission.

“Psoriasis and inflammatory myopathies share immunopathogenic pathways, including the IL-17/IL-23 axis, type I interferons, and TNF-α,” the authors reported. This overlap may complicate treatment, as biologic agents effective in PsA, such as tumor necrosis factor or IL-17 inhibitors, can exacerbate inflammatory myopathies.

The patient ultimately responded to a combination of baricitinib and low-dose prednisone, achieving sustained remission. The case adds to a small but growing body of evidence suggesting that Janus kinase inhibitors may offer a more favorable profile in overlap syndromes, balancing efficacy across musculoskeletal, dermatologic, and pulmonary manifestations.

“Our patient achieved sustained remission with baricitinib and low-dose prednisone after multiple treatment adjustments,” the authors noted.

Among the 17 previously reported cases, clinical features varied, but the presence of ILD and seropositivity for anti-synthetase antibodies was consistent across most patients. Treatment responses were mixed, highlighting the absence of a standardized approach.

The authors stress that clinicians should carefully evaluate new systemic symptoms in patients with PsA, particularly in the presence of pulmonary involvement or muscle weakness. “Clinicians should recognize overlapping features and optimize treatment to prevent exacerbations,” they concluded.

This report emphasizes the need for multidisciplinary coordination and individualized therapy in managing PsA–myopathy overlap cases, as well as further research to inform evidence-based treatment protocols.

Reference
Yan R, Ke D, Zhang Y, et al. Clinical features and therapeutic challenges of psoriatic arthritis coexisting with antisynthetase syndrome: a case report and literature review. Front Immunol. 2025;16:1626226. doi:10.3389/fimmu.2025.1626226