1224 - Progressive Proximal Muscle Weakness Leading to Diagnosis of Polymyositis and Systemic Sclerosis Overlap Syndrome

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

FH

Fadhil Hussain, DO

Resident Physician
OhioHealth Riverside Methodist Hospital
Cincinnati, Ohio, United States

Co-Author(s)

JP

John S. Pedrick, MD

Physician
OhioHealth Physician Group
Columbus, Ohio, United States

Submitter(s)

FH

Fadhil Hussain, DO

OhioHealth Riverside Methodist Hospital
Cincinnati, Ohio, United States

Case Diagnosis: Polymyositis and Systemic Sclerosis Overlap Syndrome (PM/Scl Overlap Syndrome)

Case Description:
A 68-year-old woman presented with one year of generalized edema, progressive proximal muscle weakness, and subacute dyspnea. Formerly walking 4-5 miles daily, she could only manage a few steps. Labs revealed elevated muscle enzymes, troponin, and positive PM/Scl antibodies. Cardiac MRI showed myocardial inflammation; EMG demonstrated diffuse inflammatory myopathy. She improved with corticosteroids and IVIG and was discharged with PT arranged. As an outpatient, she began an immunosuppressant. Weeks later, she was re-hospitalized with worsening symptoms and a scleroderma renal crisis. She received repeat IVIG, increased immunosuppression, and was started on ACE inhibitors and beta blockers. PT/OT were planned following stabilization.

Discussions:
PM/Scl overlap syndrome is a rare autoimmune disorder with high rates of pulmonary and cardiac involvement, contributing to morbidity and mortality. Management is challenging: corticosteroids improve myositis but increase the risk of scleroderma renal crisis. Immunosuppressants are used to taper steroids and reduce complications.

Rehabilitation is essential for this population. Profound weakness, fatigue, cardiopulmonary limitations, and contractures place patients at high risk for long-term disability. Evidence shows that aerobic and resistance training safely improve muscle strength, endurance, and quality of life in established inflammatory myopathies; however, not in new onset/active disease. In systemic sclerosis, tailored rehabilitation has been shown to improve upper extremity function, respiratory capacity, and ADLs. Individualized PT/OT preserves mobility, reduces disability, and supports independence. Programs should balance aerobic and resistance exercise, with adaptive equipment and psychosocial support considered as needed.

Conclusions:
This case highlights the complexity of PM/Scl overlap syndrome, where immunologic control must be paired with comprehensive rehabilitation. A proper rehabilitation plan is critical to restoring function and optimizing quality of life.