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<div class="noeditbox">Welcome to [[Pathophysiology of Complex Patient Problems|PT 635 Pathophysiology of Complex Patient Problems]] This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div><div class="editorbox"> | | ||
<div class="noeditbox">Welcome to [[Pathophysiology of Complex Patient Problems|PT 635 Pathophysiology of Complex Patient Problems]] This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div><div class="editorbox"> | |||
'''Original Editors '''- [[Pathophysiology of Complex Patient Problems|Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.]] | '''Original Editors '''- [[Pathophysiology of Complex Patient Problems|Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.]] | ||
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | ||
</div> | </div> | ||
== Definition/Description == | == Definition/Description == | ||
Mixed connective tissue disease (MCTD) is a systemic disease which consists of clinical symptoms observed in the three following disorders: systemic lupus erythematosus, polymyositis, and systemic sclerosis.<sup><ref name="Fagundes">Fagundes MN, Caleiro MT, Navarro-rodriguez T, et al. Esophageal involvement and interstitial lung disease in mixed connective tissue disease. Respir Med [Internet]. 2009 [cited 2016 Mar 12];103(6):854-60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19201182</ref> <ref name="medscape">Mixed Connective-Tissue Disease: Background, Pathophysiology, Etiology [Internet]. Emedicine.medscape.com. 2016 [cited 8 April 2016]. Available from: http://emedicine.medscape.com/article/335815-overview</ref></sup> MCTD is considered an overlapping disease due to the features of these three disorders which can be categorized broadly as arthritic changes, cardiopulmonary dysfunctions, skin changes, muscle weakness, kidney disease, and dysfunctions of the esophagus.<sup><ref name="NORD">Mixed Connective Tissue Disease (MCTD) - NORD (National Organization for Rare Disorders) [Internet]. NORD (National Organization for Rare Disorders). 2016 [cited 8 April 2016]. Available from: http://rarediseases.org/rare-diseases/mixed-connective-tissue-disease-mctd/</ref></sup> | Mixed connective tissue disease (MCTD) is a systemic disease which consists of clinical symptoms observed in the three following disorders: systemic lupus erythematosus, polymyositis, and systemic sclerosis.<sup><ref name="Fagundes">Fagundes MN, Caleiro MT, Navarro-rodriguez T, et al. Esophageal involvement and interstitial lung disease in mixed connective tissue disease. Respir Med [Internet]. 2009 [cited 2016 Mar 12];103(6):854-60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19201182</ref> <ref name="medscape">Mixed Connective-Tissue Disease: Background, Pathophysiology, Etiology [Internet]. Emedicine.medscape.com. 2016 [cited 8 April 2016]. Available from: http://emedicine.medscape.com/article/335815-overview</ref></sup> MCTD is considered an overlapping disease due to the features of these three disorders which can be categorized broadly as arthritic changes, cardiopulmonary dysfunctions, skin changes, muscle weakness, kidney disease, and dysfunctions of the esophagus.<sup><ref name="NORD">Mixed Connective Tissue Disease (MCTD) - NORD (National Organization for Rare Disorders) [Internet]. NORD (National Organization for Rare Disorders). 2016 [cited 8 April 2016]. Available from: http://rarediseases.org/rare-diseases/mixed-connective-tissue-disease-mctd/</ref></sup> | ||
The symptoms associated with the three underlying disorders do not usually present all at once.<sup><ref name="mayo">Mixed connective tissue disease - Mayo Clinic [Internet]. Mayoclinic.org. 2016 [cited 2016 Apr 8]. Available from: http://www.mayoclinic.org/diseases-conditions/mixed-connective-tissue-disease/basics/definition/con-20026515</ref></sup> In fact, it usually takes several years before the symptoms of each individual disorder present which ultimately complicates the diagnosis of MCTD.<sup><ref name="mayo" /> </sup>Typically, the hands are affected and present as the first symptom of MCTD. Swelling to the fingers or the presentation of “sausage fingers” is common.<sup><ref name="cleveland">Mixed Connective Tissue Disease [Internet]. My.clevelandclinic.org. 2016 [cited 2016 Apr 8]. Available from: https://my.clevelandclinic.org/health/diseases_conditions/hic_Mixed_Connective_Tissue_Disease</ref></sup> As the disease progresses, it can often affect the organs such as lungs, heart or the kidneys.<sup><ref name="NORD" /></sup> There is no definite cure for MCTD, however side effects can be managed through the use of medications.<sup><ref name="cleveland" /></sup><br><br> | The symptoms associated with the three underlying disorders do not usually present all at once.<sup><ref name="mayo">Mixed connective tissue disease - Mayo Clinic [Internet]. Mayoclinic.org. 2016 [cited 2016 Apr 8]. Available from: http://www.mayoclinic.org/diseases-conditions/mixed-connective-tissue-disease/basics/definition/con-20026515</ref></sup> In fact, it usually takes several years before the symptoms of each individual disorder present which ultimately complicates the diagnosis of MCTD.<sup><ref name="mayo" /> </sup>Typically, the hands are affected and present as the first symptom of MCTD. Swelling to the fingers or the presentation of “sausage fingers” is common.<sup><ref name="cleveland">Mixed Connective Tissue Disease [Internet]. My.clevelandclinic.org. 2016 [cited 2016 Apr 8]. Available from: https://my.clevelandclinic.org/health/diseases_conditions/hic_Mixed_Connective_Tissue_Disease</ref></sup> As the disease progresses, it can often affect the organs such as lungs, heart or the kidneys.<sup><ref name="NORD" /></sup> There is no definite cure for MCTD, however side effects can be managed through the use of medications.<sup><ref name="cleveland" /></sup><br><br> | ||
== Prevalence == | == Prevalence == | ||
It has been reported that 80% of individuals diagnosed with MCTD are women with the highest prevalence under the age of thirty years of age.<sup><ref name="mayo" /></sup> Other sources have reported statistics collected from patients from 5 years of age through 80, with the peak prevalence around 20 years of age. <sup><ref name="merck">Mixed Connective Tissue Disease (MCTD) [Internet]. Merck Manuals Consumer Version. 2016 [cited 2016 Apr 8]. Available from: https://www.merckmanuals.com/home/bone,-joint,-and-muscle-disorders/autoimmune-disorders-of-connective-tissue/mixed-connective-tissue-disease-(mctd)</ref></sup> It is estimated that this disease occurs in about 3.8 out of every 100,000 individuals. <sup><ref name="medscape" /> </sup><br> <br> | It has been reported that 80% of individuals diagnosed with MCTD are women with the highest prevalence under the age of thirty years of age.<sup><ref name="mayo" /></sup> Other sources have reported statistics collected from patients from 5 years of age through 80, with the peak prevalence around 20 years of age. <sup><ref name="merck">Mixed Connective Tissue Disease (MCTD) [Internet]. Merck Manuals Consumer Version. 2016 [cited 2016 Apr 8]. Available from: https://www.merckmanuals.com/home/bone,-joint,-and-muscle-disorders/autoimmune-disorders-of-connective-tissue/mixed-connective-tissue-disease-(mctd)</ref></sup> It is estimated that this disease occurs in about 3.8 out of every 100,000 individuals. <sup><ref name="medscape" /> </sup><br> <br> | ||
== Characteristics/Clinical Presentation <sup><ref name="cleveland" /></sup> == | == Characteristics/Clinical Presentation <sup><ref name="cleveland" /></sup> == | ||
| Line 27: | Line 28: | ||
The chart below lists some of the symptoms common versus uncommon symptoms in early stages of MCTD.<sup><ref name="cleveland" /></sup> | The chart below lists some of the symptoms common versus uncommon symptoms in early stages of MCTD.<sup><ref name="cleveland" /></sup> | ||
<sup>[[Image:Common.png]]</sup> | <sup>[[Image:Common.png]]</sup> | ||
<sup></sup> | <sup></sup> | ||
== Associated Co-morbidities == | == Associated Co-morbidities == | ||
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*Anemia (75%) <sup><ref name="mayo" />,<ref name="Cappelli" />,<ref name="U">Ungprasert P, Wannarong T, Panichsillapakit T, et al. Cardiac involvement in mixed connective tissue disease: a systematic review. Int J Cardiol [Internet]. 2014 [Cited 2016 Mar 12];171(3):326-30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24433611</ref></sup> | *Anemia (75%) <sup><ref name="mayo" />,<ref name="Cappelli" />,<ref name="U">Ungprasert P, Wannarong T, Panichsillapakit T, et al. Cardiac involvement in mixed connective tissue disease: a systematic review. Int J Cardiol [Internet]. 2014 [Cited 2016 Mar 12];171(3):326-30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24433611</ref></sup> | ||
*Necrosis <sup><ref name="mayo" /></sup> | *Necrosis <sup><ref name="mayo" /></sup> | ||
*Hearing loss <sup><ref name="Cappelli" /><ref name="mayo" /><ref name="cleveland" /><ref name="U" /></sup> | *Hearing loss <sup><ref name="Cappelli" /><ref name="mayo" /><ref name="cleveland" /><ref name="U" /></sup> | ||
*Sjögren syndrome (25%)<sup><ref name="medscape" /></sup><br> | *Sjögren syndrome (25%)<sup><ref name="medscape" /></sup><br> | ||
== Medications == | == Medications == | ||
Medications | Medications | ||
*Corticosteroids<sup><ref name="mayo" /><ref name="merck" /></sup> | *Corticosteroids<sup><ref name="mayo" /><ref name="merck" /></sup> | ||
*Anti-malarial drugs<sup><ref name="mayo" /></sup> | *Anti-malarial drugs<sup><ref name="mayo" /></sup> | ||
*Calcium channel blockers<sup><ref name="mayo" /></sup> | *Calcium channel blockers<sup><ref name="mayo" /></sup> | ||
*Nonsteroidal anti-inflammatory drugs<sup><ref name="medscape" /><ref name="merck" /></sup> | *Nonsteroidal anti-inflammatory drugs<sup><ref name="medscape" /><ref name="merck" /></sup> | ||
*Immunosuppressive drugs<sup><ref name="merck" /></sup> | *Immunosuppressive drugs<sup><ref name="merck" /></sup> | ||
*Calcium channel blockers<sup><ref name="medscape" /><ref name="mayo" /></sup> | *Calcium channel blockers<sup><ref name="medscape" /><ref name="mayo" /></sup> | ||
*Phosphodiesterase inhibitors<sup><ref name="medscape" /></sup> | *Phosphodiesterase inhibitors<sup><ref name="medscape" /></sup> | ||
*Endothelin receptor antagonists<sup><ref name="medscape" /></sup> | *Endothelin receptor antagonists<sup><ref name="medscape" /></sup> | ||
*Prostoglandins<sup><ref name="medscape" /></sup> | *Prostoglandins<sup><ref name="medscape" /></sup> | ||
*Proton pump inhibitors<sup><ref name="medscape" /></sup><br> | *Proton pump inhibitors<sup><ref name="medscape" /></sup><br> | ||
== Diagnostic Tests/Lab Tests/Lab Values == | == Diagnostic Tests/Lab Tests/Lab Values == | ||
Laboratory Testing Often Includes:<sup><ref name="medscape" /></sup> | Laboratory Testing Often Includes:<sup><ref name="medscape" /></sup> | ||
*Anti-U1-RNP (rubonucleoprotein) antigens | *Anti-U1-RNP (rubonucleoprotein) antigens | ||
| Line 72: | Line 73: | ||
*Routine blood chemistry<br> | *Routine blood chemistry<br> | ||
To check for systemic involvement, the following imaging testing can be performed<sup><ref name="medscape" /></sup> | To check for systemic involvement, the following imaging testing can be performed<sup><ref name="medscape" /></sup> | ||
*Chest radiography- assesses for infiltrates, effusions, and cardiomegaly | *Chest radiography- assesses for infiltrates, effusions, and cardiomegaly | ||
| Line 79: | Line 80: | ||
*Echocardiography- assesses for effusion, chest pain, pulmonary hypertension, or valvular disease<br> | *Echocardiography- assesses for effusion, chest pain, pulmonary hypertension, or valvular disease<br> | ||
Systemic involvement tests may also include cardiopulmonary testing, such as:<sup><ref name="Van">Van der net J, Wissink B, Van royen A, Helders PJ, Takken T. Aerobic capacity and muscle strength in juvenile-onset mixed connective tissue disease (MCTD). Scand J Rheumatol [Internet]. 2010 [Cited 2016 Mar 12];39(5):387-92. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20604672</ref></sup> | Systemic involvement tests may also include cardiopulmonary testing, such as:<sup><ref name="Van">Van der net J, Wissink B, Van royen A, Helders PJ, Takken T. Aerobic capacity and muscle strength in juvenile-onset mixed connective tissue disease (MCTD). Scand J Rheumatol [Internet]. 2010 [Cited 2016 Mar 12];39(5):387-92. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20604672</ref></sup> | ||
*Electrocardiography | *Electrocardiography | ||
| Line 87: | Line 88: | ||
<br> | <br> | ||
<sup></sup>Currently, there are three different criteria sets given by three authors: Modified Sharp et al (1987), Alarcon Segovia et al (1987), Kauskawa et al (1987).<ref name="U" /> However, there is no standard or universal criteria set. There are currently three different criteria classification systems that are associated to predicting the probability that an individual may have MCTD. Listed below are the criteria sets that are presently used in the diagnosing MCTD.<br> | <sup></sup>Currently, there are three different criteria sets given by three authors: Modified Sharp et al (1987), Alarcon Segovia et al (1987), Kauskawa et al (1987).<ref name="U" /> However, there is no standard or universal criteria set. There are currently three different criteria classification systems that are associated to predicting the probability that an individual may have MCTD. Listed below are the criteria sets that are presently used in the diagnosing MCTD.<br> | ||
== Etiology/Causes == | == Etiology/Causes == | ||
| Line 93: | Line 94: | ||
The exact cause of MCTD is unknown, but it has been classified as an autoimmune disorder. Individuals with this disease have high levels of antinuclear antibodies (ANAs) and antibodies to U1 snRNP.<sup><ref name="NORD" /> </sup>Due to the high number of autoimmune antigens in the body, the body will try to protect itself but instead attack healthy tissues. | The exact cause of MCTD is unknown, but it has been classified as an autoimmune disorder. Individuals with this disease have high levels of antinuclear antibodies (ANAs) and antibodies to U1 snRNP.<sup><ref name="NORD" /> </sup>Due to the high number of autoimmune antigens in the body, the body will try to protect itself but instead attack healthy tissues. | ||
MCTD has been linked to occur in individuals who report in having a family member who also has a connective tissue disease.<sup><ref name="cleveland" /></sup> Also, certain exposures to chemicals or viruses such as silica or polyvinyl chloride have been found as potential causes of MCTD.<sup><ref name="cleveland" /></sup><br> | MCTD has been linked to occur in individuals who report in having a family member who also has a connective tissue disease.<sup><ref name="cleveland" /></sup> Also, certain exposures to chemicals or viruses such as silica or polyvinyl chloride have been found as potential causes of MCTD.<sup><ref name="cleveland" /></sup><br> | ||
== Systemic Involvement == | == Systemic Involvement == | ||
| Line 99: | Line 100: | ||
MCTD has a systemic component that has potentially drastic effects on many systems of the body including:<br> | MCTD has a systemic component that has potentially drastic effects on many systems of the body including:<br> | ||
[[Image:SystemicInvolvement.png]] | [[Image:SystemicInvolvement.png]] | ||
== Medical Management (current best evidence) == | == Medical Management (current best evidence) == | ||
| Line 119: | Line 120: | ||
*Energy conservation techniques<br> | *Energy conservation techniques<br> | ||
== Differential Diagnosis <sup><ref name="medscape" /></sup> == | == Differential Diagnosis <sup><ref name="medscape" /></sup> == | ||
*Systemic Lupus Erythematosus- chronic inflammatory disease characterized by protean manifestations with a relapsing and remitting course | *Systemic Lupus Erythematosus- chronic inflammatory disease characterized by protean manifestations with a relapsing and remitting course | ||
| Line 141: | Line 142: | ||
Fantò M, Salemi S, Socciarelli F, Bartolazzi A, Natale G, Casorelli I et al. A Case of Subacute Cutaneous Lupus Erythematosus in a Patient with Mixed Connective Tissue Disease: Successful Treatment with Plasmapheresis and Rituximab. Case Reports in Rheumatology [Internet]. 2013 [Cited 2016 Apr 8];2013:1-4. | Fantò M, Salemi S, Socciarelli F, Bartolazzi A, Natale G, Casorelli I et al. A Case of Subacute Cutaneous Lupus Erythematosus in a Patient with Mixed Connective Tissue Disease: Successful Treatment with Plasmapheresis and Rituximab. Case Reports in Rheumatology [Internet]. 2013 [Cited 2016 Apr 8];2013:1-4. | ||
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3745888/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3745888/ ]<br><br> | [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3745888/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3745888/ ]<br><br> | ||
== Resources <br> == | == Resources <br> == | ||
About Mixed Connective Tissue Disease | About Mixed Connective Tissue Disease | ||
[http://www.mayoclinic.org/diseases-conditions/mixed-connective-tissue-disease/basics/definition/con-20026515 www.mayoclinic.org/diseases-conditions/mixed-connective-tissue-disease/basics/definition/con-20026515] | [http://www.mayoclinic.org/diseases-conditions/mixed-connective-tissue-disease/basics/definition/con-20026515 www.mayoclinic.org/diseases-conditions/mixed-connective-tissue-disease/basics/definition/con-20026515] | ||
Help finding a rheumatologist<br>[http://www.rheumatology.org/ http://www.rheumatology.org/] | Help finding a rheumatologist<br>[http://www.rheumatology.org/ http://www.rheumatology.org/] | ||
Lupus Foundation of America, Inc.<br>[http://www.lupus.org/]<br> | Lupus Foundation of America, Inc.<br>[http://www.lupus.org/]<br> | ||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
| Line 159: | Line 160: | ||
<rss>addfeedhere|charset=UTF-8|short|max=10</rss> | <rss>addfeedhere|charset=UTF-8|short|max=10</rss> | ||
</div> | </div> | ||
<br> | <br> | ||
== References<br> == | == References<br> == | ||
Revision as of 22:28, 10 April 2016
Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!
Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Top Contributors - Erica Hunter, Laci Sattler, Bridget Ward, Vidya Acharya, Kim Jackson, Elaine Lonnemann, WikiSysop and Sehriban Ozmen
Definition/Description[edit | edit source]
Mixed connective tissue disease (MCTD) is a systemic disease which consists of clinical symptoms observed in the three following disorders: systemic lupus erythematosus, polymyositis, and systemic sclerosis.[1] [2] MCTD is considered an overlapping disease due to the features of these three disorders which can be categorized broadly as arthritic changes, cardiopulmonary dysfunctions, skin changes, muscle weakness, kidney disease, and dysfunctions of the esophagus.[3]
The symptoms associated with the three underlying disorders do not usually present all at once.[4] In fact, it usually takes several years before the symptoms of each individual disorder present which ultimately complicates the diagnosis of MCTD.[4] Typically, the hands are affected and present as the first symptom of MCTD. Swelling to the fingers or the presentation of “sausage fingers” is common.[5] As the disease progresses, it can often affect the organs such as lungs, heart or the kidneys.[3] There is no definite cure for MCTD, however side effects can be managed through the use of medications.[5]
Prevalence[edit | edit source]
It has been reported that 80% of individuals diagnosed with MCTD are women with the highest prevalence under the age of thirty years of age.[4] Other sources have reported statistics collected from patients from 5 years of age through 80, with the peak prevalence around 20 years of age. [6] It is estimated that this disease occurs in about 3.8 out of every 100,000 individuals. [2]
Characteristics/Clinical Presentation [5][edit | edit source]
The initial sign of MCTD may be shown as a presentation of puffy and swollen hands, Raynaud’s phenomenon, and polyarthritis.[1][2][3][7][8]
Some of the “classical conditions or signs” of MCTD include:
- Inflammation of muscles and joints
- Pulmonary hypertension
- Raynaud’s phenomenon
- Swollen fingers, often “sausage like” and can be a temporary stage of the disease but also can progress into limited movement of the fingers due to thinning of fingers and thickening of the skin[2]
The chart below lists some of the symptoms common versus uncommon symptoms in early stages of MCTD.[5]
Associated Co-morbidities[edit | edit source]
Associated Co-morbidities
- Pulmonary Hypertension [2][4][5]
- Interstitial lung disease (20%) [4]
- Heart disease [4]
- Kidney damage (25%) [4]
- Digestive tract damage [4], [7]
- Anemia (75%) [4],[8],[9]
- Necrosis [4]
- Hearing loss [8][4][5][9]
- Sjögren syndrome (25%)[2]
Medications[edit | edit source]
Medications
- Corticosteroids[4][6]
- Anti-malarial drugs[4]
- Calcium channel blockers[4]
- Nonsteroidal anti-inflammatory drugs[2][6]
- Immunosuppressive drugs[6]
- Calcium channel blockers[2][4]
- Phosphodiesterase inhibitors[2]
- Endothelin receptor antagonists[2]
- Prostoglandins[2]
- Proton pump inhibitors[2]
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
Laboratory Testing Often Includes:[2]
- Anti-U1-RNP (rubonucleoprotein) antigens
- Urinalysis
- Muscle enzymes (myositis involvement)
- Complete blood count (CBC)
- Antinuclear antibodies
- Lipase and amylase (pancreatitis involvement)
- Routine blood chemistry
To check for systemic involvement, the following imaging testing can be performed[2]
- Chest radiography- assesses for infiltrates, effusions, and cardiomegaly
- MRI- asses for neuropsychiatric signs or symptoms
- CT scan/ultrasound- evaluates abdominal pain in cases of suspected serositis, pancreatitis, and/or visceral perforation related to vasculitis
- Echocardiography- assesses for effusion, chest pain, pulmonary hypertension, or valvular disease
Systemic involvement tests may also include cardiopulmonary testing, such as:[10]
- Electrocardiography
- Pulmonary function tests
- Six minute walk test [3]
Currently, there are three different criteria sets given by three authors: Modified Sharp et al (1987), Alarcon Segovia et al (1987), Kauskawa et al (1987).[9] However, there is no standard or universal criteria set. There are currently three different criteria classification systems that are associated to predicting the probability that an individual may have MCTD. Listed below are the criteria sets that are presently used in the diagnosing MCTD.
Etiology/Causes[edit | edit source]
The exact cause of MCTD is unknown, but it has been classified as an autoimmune disorder. Individuals with this disease have high levels of antinuclear antibodies (ANAs) and antibodies to U1 snRNP.[3] Due to the high number of autoimmune antigens in the body, the body will try to protect itself but instead attack healthy tissues.
MCTD has been linked to occur in individuals who report in having a family member who also has a connective tissue disease.[5] Also, certain exposures to chemicals or viruses such as silica or polyvinyl chloride have been found as potential causes of MCTD.[5]
Systemic Involvement[edit | edit source]
MCTD has a systemic component that has potentially drastic effects on many systems of the body including:
Medical Management (current best evidence)[edit | edit source]
add text here
Physical Therapy Management (current best evidence)[edit | edit source]
Since there has been limited research regarding physical therapy treatment in patients with MCTD, interventions should be tailored to address the impairments of each individual. Although each person presents differently, there are some common areas that need to be addressed in all cases. Individuals with MCTD often present with decreased aerobic capacity and weakness of the proximal musculature.[10] Physical therapists should treat according to the common deficits seen in the disease as well as personal impairments that arise with each case.
Common areas of focus may include:
- Educate patient regarding joint protection
- Aerobic and endurance training
- Range of motion exercises to maintain available range
- Passive stretching, including splinting for joint protection
- Strengthening total body exercises (including proximal musculature)
- Skin education and management
- Energy conservation techniques
Differential Diagnosis [2][edit | edit source]
- Systemic Lupus Erythematosus- chronic inflammatory disease characterized by protean manifestations with a relapsing and remitting course
- Scleroderma- progressive skin hardening and induration
- Dermatomyositis- idiopathic inflammatory myopathy with characteristic signs commonly present in the skin, muscles, and joints
- Polymyositis- idiopathic inflammatory myopathy which results in symmetrical proximal muscle weakness
- Primary pulmonary hypertension- elevated pulmonary artery pressure with no known cause, if left untreated will lead to right-sided heart failure
- Raynaud phenomenon- recurrent vasospasms of the fingers or toes which usually occurs as a result of stress or exposure to the cold
- Bacterial sepsis- the presence of infection along with the systemic inflammatory response syndrome
- Pleuritis- inflammation in the lining of the lungs
- Rheumatoid arthritis- chronic systemic inflammatory disease with an unknown cause
Case Reports/ Case Studies[edit | edit source]
Karmacharya P, Mainali N, Aryal M, Lloyd B. Recurrent case of ibuprofen-induced aseptic meningitis in mixed connective tissue disease. Case Reports [Internet]. 2013 [2016 Apr 8];2013(apr30 1):bcr2013009571-bcr2013009571. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645838/
Souto Filho J, de Barros P, da Silva A, Barbosa F, Ribas G. Thrombotic Thrombocytopenic Purpura Associated with Mixed Connective Tissue Disease: A Case Report. Case Reports in Medicine [Internet]. 2011 [Cited 2016 Apr 8];2011:1-5.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170900/
Fantò M, Salemi S, Socciarelli F, Bartolazzi A, Natale G, Casorelli I et al. A Case of Subacute Cutaneous Lupus Erythematosus in a Patient with Mixed Connective Tissue Disease: Successful Treatment with Plasmapheresis and Rituximab. Case Reports in Rheumatology [Internet]. 2013 [Cited 2016 Apr 8];2013:1-4.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3745888/
Resources
[edit | edit source]
About Mixed Connective Tissue Disease
Help finding a rheumatologist
http://www.rheumatology.org/
Lupus Foundation of America, Inc.
[1]
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
Extension:RSS -- Error: Not a valid URL: addfeedhere|charset=UTF-8|short|max=10
References
[edit | edit source]
- ↑ 1.0 1.1 Fagundes MN, Caleiro MT, Navarro-rodriguez T, et al. Esophageal involvement and interstitial lung disease in mixed connective tissue disease. Respir Med [Internet]. 2009 [cited 2016 Mar 12];103(6):854-60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19201182
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 Mixed Connective-Tissue Disease: Background, Pathophysiology, Etiology [Internet]. Emedicine.medscape.com. 2016 [cited 8 April 2016]. Available from: http://emedicine.medscape.com/article/335815-overview
- ↑ 3.0 3.1 3.2 3.3 3.4 Mixed Connective Tissue Disease (MCTD) - NORD (National Organization for Rare Disorders) [Internet]. NORD (National Organization for Rare Disorders). 2016 [cited 8 April 2016]. Available from: http://rarediseases.org/rare-diseases/mixed-connective-tissue-disease-mctd/
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 Mixed connective tissue disease - Mayo Clinic [Internet]. Mayoclinic.org. 2016 [cited 2016 Apr 8]. Available from: http://www.mayoclinic.org/diseases-conditions/mixed-connective-tissue-disease/basics/definition/con-20026515
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 Mixed Connective Tissue Disease [Internet]. My.clevelandclinic.org. 2016 [cited 2016 Apr 8]. Available from: https://my.clevelandclinic.org/health/diseases_conditions/hic_Mixed_Connective_Tissue_Disease
- ↑ 6.0 6.1 6.2 6.3 Mixed Connective Tissue Disease (MCTD) [Internet]. Merck Manuals Consumer Version. 2016 [cited 2016 Apr 8]. Available from: https://www.merckmanuals.com/home/bone,-joint,-and-muscle-disorders/autoimmune-disorders-of-connective-tissue/mixed-connective-tissue-disease-(mctd)
- ↑ 7.0 7.1 Tani C, Carli L, Vagnani S, et al. The diagnosis and classification of mixed connective tissue disease. J Autoimmun [Internet]. 2014 [Cited 2016 Mar 12];48-49:46-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24461387
- ↑ 8.0 8.1 8.2 Cappelli S, Bellando randone S, Martinović D, et al. "To be or not to be," ten years after: evidence for mixed connective tissue disease as a distinct entity. Semin Arthritis Rheum [Internet]. 2012 [cited 2016 Mar 12];41(4):589-98. Available from http://www.ncbi.nlm.nih.gov/pubmed/21959290
- ↑ 9.0 9.1 9.2 Ungprasert P, Wannarong T, Panichsillapakit T, et al. Cardiac involvement in mixed connective tissue disease: a systematic review. Int J Cardiol [Internet]. 2014 [Cited 2016 Mar 12];171(3):326-30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24433611
- ↑ 10.0 10.1 Van der net J, Wissink B, Van royen A, Helders PJ, Takken T. Aerobic capacity and muscle strength in juvenile-onset mixed connective tissue disease (MCTD). Scand J Rheumatol [Internet]. 2010 [Cited 2016 Mar 12];39(5):387-92. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20604672
