and Mixed Connective
may require steroids or immunosuppressants such as A range of fact sheets are available as follows:
Tissue Disease
Further investigations required according to specialist centre and requires highly specialised management Drugs used in MCTD
Steroids, either oral, intramuscular or intravenous, are used when the disease is active in order to gain control. These are often used for those with internal organ problems and drugs that suppress the immune system, such as Methotrexate, Azathioprine or Cyclophosphamide, are used to help reduce the steroid dose over time and maintain remission. Whilst these drugs do carry some significant potential side effects, the risks of these are always outweighed by the risks of a very active disease such as MCTD and doses are always kept to a minimum to help reduce and minimise risk. 18. LUPUS and Mixed Connective Tissue Disease LUPUS UK is the registered national charity caring for people with lupus and has over 6,000 members who are supported by the Regional Groups.
Take home messages
LUPUS UK acknowledges with gratitude the assistance of Sue Brown MSc RGN NIP EN (G) Consultant Nurse in MCTD is a less commonly seen connective tissue disease that Rheumatology (Connective Tissue Diseases) Royal can cause a wide variety of different symptoms. Whilst some National Hospital for Rheumatic Diseases NHS can develop internal organ complications, this is not always the case. There are three important messages for you to Foundation, Bath in the provision of clinical information towards the production of this fact sheet.
Learning to live with and finding ways to manage your symptoms are important parts of coming to (Northumberland) for their valued fundraising towards the 2. You can improve symptoms such as fatigue by
pacing and planning periods of activity and rest, listening to your body and setting realistic achievable Please contact National Office should you require further goals (more information can be found about these in information about lupus. LUPUS UK will be pleased to provide a booklist and details of membership.
3. Pay attention to the variant or type of MCTD that you
have and keep in touch with your rheumatology team if you develop any new symptoms or if you are at all TEL: 01708 731251
Joint pain and Painkillers such as Paracetamol or ymptoms of MCTD
some, drugs like Hydroxychloroquine Rheumatoid or Methotrexate can be used. If and Mixed Connective
The most commonly seen symptoms in MCTD include: Tissue Disease
hat is Mixed Connective
Tissue Disease?
• Tight skin and/or ‘sausage-shaped’ digits Mixed connective tissue disease (MCTD) is an auto-immune • Dysphagia - Difficulty in swallowing disease that was first recognised in 1972 and is considered to • Trigeminal neuralgia – inflammation of the nerves affecting be a cousin of lupus. We now understand that there can be an overlap in many auto-immune diseases that may involve any number of different variants of connective tissue diseases. MCTD is the commonest seen combination, and symptoms of Complications of MCTD
MCTD usually either appear as a lupus or a scleroderma variant. Some people have a polymyositis variant so have problems with muscle inflammation as well. Often with time, Some people with MCTD can develop internal organ problems MCTD may evolve into one of the conditions of lupus, although this is rarer. All people with MCTD should pay scleroderma or polymyositis. Dermatomyositis can also be attention to any new episodes of breathlessness and/or heart seen when the inflammation affects the skin as well as the palpitations. Regular heart and lung investigations should always be requested in order to look out for possible signs of interstitial lung disease (ILD) or pulmonary hypertension. These development of digital ulcers especially conditions, although in some cases serious, are now much iagnosing MCTD
better diagnosed and treated in specialist centres that see people with MCTD on a regular basis. Investigations need to be balanced according to symptoms and for many, these For many, to gain a diagnosis of any connective tissue disease is difficult and this is still the case for MCTD. As the immune system is over-active in these conditions, most people with MCTD will have positive Anti-Nuclear Antibodies (ANA) and Treatments for MCTD
also antibodies to ribonuceloprotein (RNP). The specific antibody for MCTD is called Anti-U1-RNP. Other diagnoses should always be excluded before coming to a diagnosis of Treatments for MCTD vary dependent on the types of MCTD, especially in people who do not carry any MCTD symptoms that you may have. The following table describes some of the treatments used, but it is important to remember that your specialist team will always assess how active your disease is and suggest treatments according to your variant of ho gets MCTD?
MCTD. This table describes the symptoms and important points and in which variant you would expect these to occur. As is seen in many other rheumatological conditions, more Symptoms
Treatments and important
women than men have MCTD and it can occur at any age. Children can be diagnosed with MCTD, where Raynaud's phenomenon (a circulatory disorder affecting mostly the hands and feet), fatigue and pain tend to be the commonest symptoms. As signs and symptoms can change over time, children with a diagnosis of MCTD should always be closely monitored and these should be acted upon if any other prevent side effects associated with medication


Special/atypical bacteriology

1. Last Name First Name DO NOT WRITE IN THIS SPACE N.C. Department of Health and Human Services State Laboratory of Public Health 2. Patient Number Submitter Laboratory/Medical Record #: _____________________ 3. Address _ t _ e _ _ o _ f PLEASE GIVE ALL Month Day Year INFORMATION REQUESTED 5. Race  1. White  2. Black  3. American Indian  4


Literatur 1. Adams T, Heisey RS, Smith MC, Briner BJ. Parietal bone mobility in the anesthetized cat. J Am Osteopath Assoc. 1992;92:599--622. Amprino R. Bone Histophysiology. Guy’s Hospital Rep. 1967;116:51--69. Andres KH. Über die Feinstruktur der Arachnoidea und Dura mater von Mammalia. Z Zellforsch. 1967;79:272--295. Australian Physiotherapy Association. Protocol after 6 years. Man T

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