The arthritis of mixed connective tissue disease.

Abstract

SUMMARY Twenty patients with mixed connective tissue disease were followed for 5 years. Arthritis occuured in all 20 patients, being the presenting complaint in 11 patients. The joints most frequently involved were the proximal interphalangeal (PIP), metacarpophalangeal (MCP), wrists, metatarsophalangeal (MTP), and knee; the distribution tended to be symmetrical, mimicking early rheumatoid arthritis. Joint deformities occurred in 6 patients, but apart from 1 patient with arthritis mutilans, significant functional impairment was not encountered. Radiologically small punched out bone erosions, asymmetrically distributed, were the most characteristic finding; other notable changes were aseptic necrosis, tuft erosions, and periarticular calcification. Joint effusions were noninflammatory, the cellular content was predominantly lymphocytic and the C3 level was normal. Most cases were controlled with non-steroidal anti-inflammatory agents and invariably responded to prednisone .7 * 5 mg/day.

Acroosteolysis in Systemic Lupus Erythematosus

“…9,10 Mutilans arthropathy has been reported previously as a manifestation of psoriatic arthritis, 11Y13 systemic sclerosis, 2 and mixed connective tissue disease. 2 In mixed connective tissue disease and systemic sclerosis, the presence of acroosteolysis is conditioned by an ischemic process due to small vessel damage and is closely associated with Raynaud phenomenon. 2,14 In the present case, there were no suggestive data to consider any of these 3 alternative diagnoses.…”

“…2 In mixed connective tissue disease and systemic sclerosis, the presence of acroosteolysis is conditioned by an ischemic process due to small vessel damage and is closely associated with Raynaud phenomenon. 2,14 In the present case, there were no suggestive data to consider any of these 3 alternative diagnoses. At this time, there is no clear physiopathological model that describes the mechanism to develop an…”

Mixed Connective Tissue Disease, a Roundabout to Rheumatic Diseases?

“…Sometimes it is severe and associated with digital necrosis representing a major cause of morbidity. Arthritis and arthralgias are also common, but again a unique pattern is lacking [15]. Myositis, fibrosing alveolitis and pulmonary hypertension are the most important common features of the syndrome and the last one is also the major cause of death.…”

Treatment of Mixed Connective Tissue Disease

“…A symmetric polyarthritis that resembles rheumatoid arthritis (RA) occurs in approximately 60% of patients and may be accompanied by joint deformities and characteristic mild erosive changes on radiographs [19,29]. Destructive arthritis, however, including an arthritis mutilans type, also has been described in MCTD [30][31][32]. Small peritendinous nodules near tendons of forearms and hands have been reported in some patients [33].…”