Dear Dr. Donohue: For years, my doctor treated me for arthritis. Now he's done an about-face and says I have something called mixed connective tissue disease. What happened to my arthritis? I feel like I have wasted years on the wrong treatment. Care to comment?
R.J.
Your story is classic for mixed connective tissue disease, MCTD.
The connective tissues support the body, serve as the body's scaffold and act as packing material. Ligaments, tendons, joints, cartilage and bones are connective tissues.
Collagen is a protein common to these tissues.
Rheumatoid arthritis, lupus, scleroderma, polymyositis and dermatomyositis are the connective tissue disorders. In the early days of MCTD, patients almost always are told they have one of those five illnesses.
The symptoms of MCTD include muscle and joint pain and fatigue. Most patients have Raynaud's phenomenon.
Upon exposure to cold, the arteries that supply the hands turn white, blue and red, and hurt.
The arteries have constricted in an exaggerated way in response to cold. Raynaud's also is seen in the other connective-tissue disorders.
Later in MCTD, hands swell and fingers become puffy. That's a sign that helps distinguish MCTD.
What helps to finally hit on the diagnosis of MCTD is finding a unique antibody in the blood of patients. It's often not present from the start of the illness.
Treatment medicines are hydroxychloroquine and methotrexate. When need be, prednisone, one of the cortisone drugs, is prescribed. Most patients with MCTD respond to it very well.
Your doctor did a great job in finally making the diagnosis. It takes doctors years before they can piece the puzzle of MCTD together.
It's an elusive illness.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him at P.O. Box 536475, Orlando, FL 32853-6475.
