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We report a case of a 24-year-old female with a history of asthma and gastroesophageal reflux disease (GERD). She presented to the emergency room with severe chest pain, chest tightness, and shortness of breath following an upper respiratory tract infection. The patient reported that she had a cough and runny nose one week prior to this presentatio...
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... [1] The diagnosis of MCTD is a challenging task because of the presence of overlapping symptoms of other connective tissue disorders. [2] The mean age of presentation of MCTD is 31.9 years. ...
... A previous study by Amigues et al reported that about 60% of patients 17 This is comparable to a study in the Philippines in which the chief complaint was most commonly joint pain, at 67%. 18,19 The first diagnosis in 10% had a full blown picture of MCTD (SLE, SS, DM), is similar to a study in Minnesota, USA which reported that the annual incidence of MCTD was 1.9 per 100,000 population. 20 Our study showed that 40% evolved from SLE, 26.7% evolved from RA, 6.7% from SS, and 3.3% evolved from PM to MCTD, similar to a study in Pakistan which found that, over the disease course of 6 years, 10% of patients evolved into SLE. Also this is comparable to the Minnesota study, in which evolution from other connective tissue diseases occurred at 8.5% and 6.3% for SLE and SS, respectively. ...
Background: Mixed connective tissue disease (MCTD) is a rare autoimmune disease, characterized by the production of specific autoantibody anti-RNP, which presents with varied overlapping symptoms of different connective tissue disorders. The aim of this study is to identify the frequency and patterns of MCTD. Methods: This is a descriptive cross-sectional hospital-based study conducted at the rheumatology clinic at Omdurman Military Hospital between February 2019 and July 2019. The study included 30 patients and data were collected using a designated questionnaire. Results: The study showed that the majority of patients (96.7%) were females and only 3.3% was male. About 30% of the patients aged between 30 and 39 years were the most affected. As a first diagnosis, 10% of the patients had a MCTD fulfilling the Alarcon-Segovia criteria. The remaining 90% of the patients were diagnosed with other diseases before evolving into MCTD. The most common clinical presentation was arthralgia in 100% of the patients, 90% were symmetrically followed by myositis in 70% of the patients, arthritis in 63.3% of the patients, puffy fingers in 63.3% of the patients, and hand swelling in 60% as major musculoskeletal symptoms. Regarding the initial results in immunological profile, the most common positive autoantibodies among the patients were anti-RNP titer in 96.7% of the patients, ANA in 90%, anti-Sm in 50%, RF in 50%, anti-Ds DNA in 46.7%, and anti-Ro in 43.3%. Conclusion: This study showed that MCTD is more common in females, only 10% of patients presented with a fulfilling criteria of the disease at diagnosis, and the rest of the patients presented with other rheumatologic diseases before evolving into MCTD.
Keywords: MCTD, females, arthralgia, anti-RNP titer
Connective tissue diseases (CTD) are heterogeneous, immune-mediated inflammatory disorders often presenting with multiorgan involvement. With the advent of high-resolution computed tomography, CTD-related pleuritis—pleural thickening and effusion—is now increasingly recognized early in the disease trajectory. The natural history of CTD-related pleural effusions varies from spontaneous resolution to progressive fibrothorax with ventilatory impairment. Treatment of the underlying CTD is necessary to manage the pleural disease. Depending on the degree of symptom burden and physiological insult, specific treatment of pleural disease can include monitoring, repeated aspirations, systemic anti-inflammatory medication, and surgical decortication.
