MCTD?

[Daneluvr]

Hi.  I'm new to the rheumatology world.  I had a positive ANA and elevated titer over 20 years ago and never followed up with a rheumatologist after having fluid drained from my knee.  My blood work was recently positive ANA 1:80, homogeneous.  I was referred to a rheumatologist who ran further blood work.  Second blood result was positive ANA 1:80, homogeneous/speckled and positive RNP.  Followup appointment today.  Rheumatologist said that your lab did not give me the RNP numbers, just a positive.  You don't have any markers for Lupus.  Followup in 4 months and that she has prescribed a low dose antidepressant for my "algia" and said she suspects it's hormonal.  

History and symptoms:  56 year old female in menopause.  I am a kidney donor and only have one kidney, so this is important to me.  Severe night sweats, intermittent pain and swelling in knees.  Also intermittent pain in all joints.  History of back problems and arthritis in back.  Bunions and extreme pain in feet.  History of Renaud's.  Chronic dry mouth, dry eyes, problems swallowing, swollen larynx (ENT said due to reflux).  I have strange patches of skin sensitivity that lasts a couple of days, where it is mildly painful to touch.  History of being anemic.  Insomnia and anxiety attacks.  Fatigue, apathy, lack of appetite and lack of energy.  

I hate going to doctors and this is why I never followed up.  Now, that I have unexplained symptoms, I'd like to figure out what's going on.  

TIA.

My research indicates possible MCTD.  My doctor didn't event mention MCTD, only that I didn't appear to have the markers and was too old for a dx of Lupus.  Rheumatologist was short, and didn't seem interested in repeating the blood work to get the "numbers" for the positive RNP.  Didn't seem interested in going over my symptoms or diagnosing anything.  

[Red_Star]

RACGP - Antinuclear antibody test...

"ANA pattern - associated rheumatic disease:

Homogeneous:
Systemic lupus erythematosus
Mixed connective tissue disease
Drug induced lupus
Juvenile idiopathic arthritis

Speckled:
Systemic lupus erythematosus
Sjögren's syndrome
Polymyositis/dermatomyositis
Systemic sclerosis/scleroderma

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GP Notebook- Anti RNP...

"This is antibody to a cytoplasmic ribonuclear protein complex

nRNP antibody

- target U1-RNP
- positive in 15% systemic sclerosis
- clinical association
- overlap features of SLE, arthritis
- associated with mixed connective disease and SLE with particular features (arthritis, myositis, Raynaud's phenomenon - also association with HLA-DR4 and HLA-DQw8)

Reference:

1) Arthritis Research Campaign (2010). Topical Reviews - Systemic sclerosis and related disorders."

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FP Notebook - Anti-ribonucleoprotein Antibody...

Positive (percentage refers to sensitivity)

1. Systemic Lupus Erythematosus (30-40%)
- Correlates with disease activity
2. Rheumatoid Arthritis (10%)
3. Sjogren's Syndrome (15%)
4. Mixed Connective Tissue Disease (95%)
5. Systemic Sclerosis (30%)
6. Drug Induced Lupus (<5%)

References:
Gladman in Klippel (1997) Rheumatic Diseases p. 255-6
Peng in Ruddy (2001) Kelley's Rheumatology, p. 161-72
Callegari (1995) Postgrad Med, 97(4):65-74 [PubMed]
Lane (2002) Am Fam Physician 65(6):1073-80 [PubMed]"

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Lupus Facts and Statistics - National Resource Center on Lupus..

"The age of onset for lupus is typically between 15 and 40 years old, but up to 25 percent of people diagnosed with the disease have late-onset lupus."