Friday, June 10, 2011

Mixed Connective Tissue Disease (MCTD)


This is the first in a series of posts about diseases that are either very similar to, or often associated with, lupus. I plan to cover both Raynaud’s and Sjögren's syndromes in subsequent posts. 

Diagnosing Difficult Cases
While it would be nice to say that each autoimmune disease has separate and distinct symptoms, the fact is that there is a great deal of overlap between them. This makes diagnosing diseases quite difficult. If I have enough symptoms to be diagnosed with lupus but I also have symptoms more commonly seen in rheumatoid arthritis (RA) should I also be diagnosed with RA? Would it be better for my doctor to say instead that  I just have unusual lupus symptoms? And if RA and lupus are treated the same way, does it even matter?

The fact is that biology doesn’t conform well to hard and fast rules. The immune system is particularly difficult this way; I used to tell my undergraduate immunology students that every rule they learned in class would have an exception somewhere. Since the immune system itself doesn’t follow strict rules, it should come as no great surprise that autoimmune diseases don’t either. I regard autoimmune diseases as being points on a continuum, rather than existing as discrete entities. These diseases all share in common the fact that the immune system has lost the ability to tell whether various tissues in the body are part of the body or whether they are invading germs. Specific autoimmune diseases are diagnosed depending on which parts of the body are being attacked, and by which parts of the immune system are doing the attacking.

Most people with autoimmune diseases have enough symptoms specific to a specific disease to receive a specific diagnosis. But for some, their symptoms really don’t fit neatly into a disease category. These people are often diagnosed with Mixed Connective Tissue Disorder, or MCTD. It is not uncommon for people with MCTD to initially be diagnosed with, for example, lupus. Often it takes time for distinctly non-lupus like symptoms to appear. Only after it is clear that the symptoms do not all fit into one disease that a doctor will give the MCTD diagnosis.

What is connective tissue, anyway?
Connective tissues are the tissues and structures in the body that serve to, you guessed it, connect different parts of the body. Tendons and ligaments are perhaps the most commonly known forms of connective tissue, but there are others. Even blood can be considered connective tissue, since it does connect and support various different organs.

Because there are so many different kinds of connective tissue, connective tissue diseases can manifest themselves in all sorts of different ways. Some people experience joint pain as the tendons keeping the joints together get attacked by the immune system. Others may have muscle problems as various muscles in the body are damaged by the immune system.

            Connective tissue literally holds the body together. This is why connective tissue diseases are so serious, and why they are treated with powerful immunosuppressants or corticosteroids.

UCTD vs MCTD?
There is some debate as to whether MCTD is the same thing as Undifferentiated Connective Tissue Disorder (UCTD). I’m going to use the Mayo Clinic’s classification, which says that the two are different.

UCTD:
The American College of Rheumatology has (somewhat arbitrarily, in my personal opinion), come up with a list of eleven symptoms that are used to diagnose lupus. Generally, a patient needs to experience at least four of the eleven symptoms to receive a formal diagnosis of systemic lupus. This can lead to a diagnostic dilemma: How should a physician diagnose somebody who has at least one, but fewer than four, symptoms?

The answer, for many physicians, is to give a diagnosis of UTCD. It is often followed by a more specific diagnosis, once more symptoms have appeared. The UCTD diagnosis is generally the physician’s way of saying, “This patient has symptoms of an autoimmune disorder, but I can’t quite classify it as a specific disease yet.” UCTD patients are often, although not always, diagnosed with lupus later on.

MCTD:
MCTD is a smorgasbord (or “overlap” if you want to be more technical) disease. It manifests in a variety of ways common to lupus, rheumatoid arthritis, polymyositis and scleroderma. Like lupus, it can lead to serious problems. For example, inflammation from both diseases may lead to heart disease and/or other cardiac complications. Lupus and MCTD can also both lead to Raynaud’s disease, a condition in which blood vessels prevent blood flow to the hands and feet.

The difference between the lupus and MCTD is hazy at best. Symptoms of lupus can be present in MCTD as well. However, not all MCTD symptoms fit into the lupus definition. If someone who was diagnosed as having lupus starts showing signs of, for example, unusual connective tissue growth (which is more common to scleroderma), (s)he may be rediagnosed as having MCTD. The new diagnosis is broader, and allows for symptoms from several related diseases.


So which is more serious, lupus or MTCD?
            It’s impossible to say. Both diseases describe such a wide variety of symptoms and a huge amount of variation between patients that ranking one over the other is impossible. My personal belief is that it’s a tie. Both cause inflammation, both are treated with similar drugs, and both can cause everything from a minor to fatal illnesses. 


The take home message? Autoimmune diseases suck, but at least they suck in a variety of strange and unusual ways.


Additional legal notes:
1) Much of the information presented here is from the mayo clinic and the ACR. Links are provided in the text.
2) My usual disclaimer applies. I am not a physician, nor can I promise that my brain fog will allow me to write without making mistakes. Please do not ever use my explanations as a substitute for talking to your doctor!

56 comments:

  1. ha! your take home message made me laugh :)
    looking forward to reading more of your blog...

    --kristin
    (lupus and other myriad of joyous health crap)

    ReplyDelete
  2. Being a scientist makes lupus more interesting, but also more frustrating. No matter how many long, thoughtful discussions I have with my immune system, it still won't do what I want! Very unreasonable of it, I feel.

    ReplyDelete
  3. Thanks for the info, I have UCTD,Fibromyalgia,DJD,Osteoarthritis, hx of 3 neck surgeries, Carpal Tunnel Syndrome,Hypothyroid,GERD,just wish I could get my life back the way it used to be before I got sick? But, just have to take it one day at a time.

    ReplyDelete
    Replies
    1. I had surgery on both my wrists for carpal tunnel last year. I found that the surgery helped a lot. As for everything else...well, as you say, one day at a time.

      Delete
  4. I have recently been told I have Lupus but I have to wait until nov to be seen that is so bad. I am thinking about what I should do. I want to go back to work. I am thinking about going to er to see someone there. Does anyone have views on this

    ReplyDelete
    Replies
    1. I'm in the same dilemma right now. I have to wait over two months to be seen by a specialist. My plan is to see if things get really bad, then go into the ER. In the meantime I'm calling doctors and yelling at them, and keeping the appointment in a couple months.

      Delete
  5. Hi there it's me, I am also visiting this web page daily, this web page is really pleasant and
    the people are in fact sharing pleasant thoughts.

    my weblog: Low T Symptoms

    ReplyDelete
  6. Wonderful blog you have here but I was curious about if you knew of any community forums that cover the
    same topics discussed here? I'd really like to be a part of group where I can get comments
    from other experienced people that share the same interest.

    If you have any suggestions, please let me know. Cheers!



    Check out my homepage ... minneapolis web design seo

    ReplyDelete
    Replies
    1. Sorry for the delay; my spam filter blocked your comment. I would suggest going to Facebook and looking for a MCTD/UCTD/Lupus group. I've met great people that way. I can't send you a link because I'm on my work computer and cannot access Facebook.

      Delete
  7. Ridiculous quest there. What happened after?
    Take care!

    Visit my blog ... Green Mountain Coffee Announces Stock Offering

    ReplyDelete
  8. Interested in seeking a support group for Connective Tissue/Lupus symptoms in the Long Island, NY area. TY!
    September 21, 2014.

    ReplyDelete
    Replies
    1. I heard there is support program at the Hospital for Special Surgery in New York

      Delete
  9. This comment has been removed by a blog administrator.

    ReplyDelete
  10. Thank you for a great laugh. I was just diagnosed with UCTD after over a year of chasing my tail. My doctors had an extra hard time due to the fact that I am a Triple Negative Breast Cancer Survivor. Having a sense of humor is the key to life!

    ReplyDelete
  11. This blog is so nice to me. I will continue to come here again and again. Visit my link as well. Good luck
    http://www.jualobataborsiherbal.com/ obat aborsi
    http://caramenggugurkankandungan.info/ cara menggugurkan kandungan
    http://obataborsi59.com/ obat aborsi
    http://obataborsi59.com/cara-menggugurkan-kandungan-dengan-cepat-dan-aman/ cara menggugurkan kandungan
    http://obattelatdatangbulan.info/ obat telat datang bulan
    http://klinikobataborsi.com/ jual obat aborsi
    http://jualobatpenggugurkandungan.net/ obat penggugur kandungan
    http://tandatandakehamilan.net/ tanda tanda kehamilan
    http://tandatandakehamilan.net/cara-cepat-dan-selamat-menggugurkan-kandungan/ cara menggugurkan kandungan

    ReplyDelete
  12. Use this article to increase your knowledge . menggugurkan kandungan

    ReplyDelete
  13. I love to see you have written this content very Well and want to write more so people will aware of this issue
    I have some favorite game Blogs as well like
    ||Happy Wheels at happywheels.in||
    ||Happy wheels game at classic happy wheels game||
    ||Happy Wheels demo at happy wheels||
    ||Fireboy and watergirl at fireboywatergirl.co||

    ReplyDelete
  14. These hazard variables may either be something which can't be changed, for example, family history, sex, or nearness of a specific quality, or ones which can be changed, for example, the propensity for smoking or having hypertension. Healthpally

    ReplyDelete
  15. An fascinating discussion is value comment. I think that it is best to write extra on this matter, it won’t be a taboo topic however generally people are not enough to talk on such topics. To the next. Cheers facial tissue machine

    ReplyDelete
  16. Case finding is a strategy for targeting resources at individuals or groups who are suspected to be at particular risk of a disease. It involves actively searching systematically for high-risk people, rather than waiting for them to present themselves to medical attention after symptoms or signs of active disease have occurred.crohns disease

    ReplyDelete
  17. I thank you for the information and articles you provided

    ReplyDelete
  18. Hello ^^
    The season when the car winds are back.
    Are you all working hard to prepare for your visit to Korea? Beware of colds and beware of corona
    I came in to see your site and I liked a lot of useful and good content!
    I also run a site, so will you come and see it?
    I think I would be very grateful for your feedback. Bye^^
    My site address: 토토사이트

    ReplyDelete
  19. Your blog is too much amazing. I have found with ease what I was looking. Moreover, the content quality is awesome. Thanks for the nudge! 먹튀검증

    ReplyDelete
  20. I really appreciate your effort in helping people get the information they need 먹튀

    ReplyDelete
  21. I am happy to find this post very useful for me, as it contains lot of information. I always prefer to read the quality content and this thing I found in you post. Thanks for sharing 먹튀검증업체

    ReplyDelete
  22. I'm really enjoying the design and layout of your site. It's a very easy on the eyes which makes it much more pleasant for me to come here and visit more often. Did you hire out a developer to create your theme? Superb work! 메이저놀이터

    ReplyDelete
  23. I can set up my new idea from this post. It gives in depth information. Thanks for this valuable information for all buy web traffic

    ReplyDelete
  24. This is very educational content and written well for a change. It's nice to see that some people still understand how to write a quality post.! 먹튀폴리스

    ReplyDelete
  25. ❤ I favor the idea, such a good deal 먹튀검증

    ReplyDelete
  26. Please take good care of me from now on.Thank you 토토사이트

    ReplyDelete
  27. It's soon enough to get a lot of information. I'm too happy to express it. 먹튀검증

    ReplyDelete
  28. It's always a pleasure to read your magnificent articles on this site. 파워볼사이트

    ReplyDelete
  29. I'm writing on this form, so I hope to see you. 메이저놀이터

    ReplyDelete
  30. I have been on the look out for such great information. 바카라사이트

    ReplyDelete
  31. My site has a discussion board for articles and photos similar to this topic. 토토사이트

    ReplyDelete
  32. This site contains a lot of really good information. Lots of useful inaformation. I'll add it to my bookmarks and stop by often.
    메이저놀이터

    ReplyDelete
  33. Thank you again for all the knowledge you distribute,Good post. I was very interested in the article, it's quite inspiring I should admit. I like visiting you site since I always come across interesting articles like this one.Great Job, I greatly appreciate that.Do Keep sharing! Regards 슬롯사이트

    ReplyDelete

  34. Thanks for your marvelous posting! I actually enjoyed reading it, you could be
    a great author.I will remember to bookmark your blog and will
    eventually come back from now on. I want to encourage you to continue your great
    writing, have a nice weekend!

    Website:カジノ

    ReplyDelete
  35. This site seems to inspire me a lot. Thank you so much for organizing and providing this quality information in an easy to understand way. I think that a healthy era of big data can be maintained only when such high-quality information is continuously produced. And I, too, are working hard to organize and provide such high-quality information. It would be nice to come in once and get information.

    Also visit my site:토토사이트


    ReplyDelete