From the desk of Dr. Moses:
This rare disease falls into the category of autoimmune and inflammatory dis-eases. I would approach it with a basic Cayce regimen that includes the treatment of inflammation through colon cleansing; proper diet, especially avoiding all refined foods and refined flour; fish oil, preferably Cod Liver Oil; Pure Extra Virgin Olive Oil, raw, put on foods or taken alone; and a generally Alkaline Diet. If there are joint manifestations, I would recommend Atomidine (Atomic Iodine), and hot Epsom Salts baths, and oil massage to the joints with peanut oil/olive oil, or Aura Glow. Spinal work or a consistent Yoga program is very effective for whole body healing. Finally, meditation and positive thinking can work wonders. In auto-immune disorders, I encourage patients to ponder any self-condemnation, guilt, judging self, or even self-pity; any negative thoughts toward yourself must be given up. Living in the Now is a great way to let go of thoughts, overall. Moreover, writing down every negative thought you have, and then saying three positive things instead, out loud, is great. The gratitude exercise is very powerful, also.
Part of a spectrum of diseases included in the Overlap Syndromes. Each disease is characterized by more than one rheumatic disease. Presentation of each disease is usually subacute and the clinical manifestations can include various organ systems depending on the features of the rheumatic disease.
- Mixed Connective Tissue Disease
- Antisynthetase syndrome
- Polymyositis/Scleroderma overlap syndrome
Characterization of MCTD: includes overlapping features of the following, in the setting of a high titer of autoantibodies to U1-ribonucleoprotein:
- Rheumatoid Arthritis
Features of MCTD (usually highly variable):
- Arthritis/Arthralgia: present in almost all patients, especially small joints, however deformities are uncommon
- Raynaud phenomenon: 90% of patients have upon presentation
- Swollen Hands
- Scelerodermatous skin changes: later manifestation
- Myositis/Myalgias: myalgias may present in 25-50% of patients but myositis is less common.
Myositis is key component of antisynthetase syndrome
- Dyspnea/Cough: 43% of patients have upon presentation—both interstitial lung disease and pulmonary hypertension may be seen
- GERD symptoms: 47% of patients have symptoms of esophageal dysmotility
- Renal Involvement occurring in 25% of patients with MCTD, rare in other overlap syndromes
- Severe central nervous system disease is rare
- Rare condition, studies on incidence and prevalence are lacking.
- Less common than SLE, as common as systemic sclerosis, more common than polymyositis
- Present between ages 20-30 y/o, female to male ratio of 10:1
- Causative factors not well known, however, has been proposed that an unidentified environmental factor may trigger onset in a genetically predisposed person.
- CBC (variable may show anemia, leukopenia)
- ESR (elevated), CRP (elevated)
- serum BUN/creatinine (nl or elevated— glumerulonephritis may occur in MCTD)
- ANA (positive)
- UA (variable, may show proteinuria, hematuria, occ RBC casts)
- U1-ribonucleoprotein (positive at high titer ** Essential for diagnosis of MCTD)
- Anti-Jo-1 (positive, higher specificity for antisynthetase syndrome)
- Directed at symptoms patient is presenting with, however, all patients need supportive care and lifestyle changes. Includes referral to rheumatologist with experience in this area.
- Encouraging patient to take responsibility for disease management
- Maintaining ideal body weight for height
- Reduction of salt intake in the presence of HTN due to renal disease
- Exercise guidelines to maintain optimum cardiovascular fitness
- Stop smoking especially in the presence of Raynaud phenomenon
- Frequency and specifics of follow-up depend on patients type and severity of clinical manifestations
- Annual echocardiograms, to eval for development of pulmonary hypertension are reasonable
- Yearly pulmonary function testing
- Monitoring for side effects of specific drug regimen: i.e. prolonged
- corticosteroid/immunosuppressant use effects