Rheumatoid Arthritis, Lupus and Mixed Connective Tissue Disease (MCTD)

I have been diagnosed Rheumatoid Arthritis.  Diagnosing RA is usually a long and drawn out process in practise, but in theory it’s very simple.

There’s a criteria.  If you meet that criteria, you have RA.

The criteria for Rheumatoid Arthritis diagnosis is a combination of blood work, x-rays or other scans, and clinical history.  If you don’t fully meet the criteria, you have suspected Rheumatoid Arthritis, and if it’s of any severity, your rheumatologist will start treatment right away.  Just in case.

The chosen treatment is dependent on the severity of the disease.  This is also a point and shoot situation.  Medicine is like that…it’s all criteria and protocols.  There’s not a lot of deviation in autoimmune arthritis treatment plans.

Methotrexate is the first drug of choice – the gold standard treatment.  Most people who have Rheumatoid Arthritis will be prescribed methotrexate at some point, but sometimes those with milder disease will start with sulfasalazine, or plaquenil.  All three together is referred to ‘triple therapy’ and has been shown to be as effective as biologicals in some studies.

You’ll be prescribed a NSAID to get the inflammation under control, because DMARDs like methotrexate are slow acting.  It can take a three months for the benefit to kick in.  If NSAIDS aren’t enough, prednisone (corticosteroids) are used to get the inflammation under control.

But what if you don’t quite meet the criteria but your disease is severe?  You get left in a wasteland of wondering what is *really* wrong with you, and if it’s actually something much worse than RA.  That’s where I was for a few years.  My rheumatologist treated me agressively for inflammatory arthritis, but he held back on an official diagnosis until I met the criteria fully.  Some rheumies don’t really care about the criteria – experience tells them if the symptoms are mild and self limiting, or severe and progressive.  The essential thing is that if the disease is moderate to severe that treatment is started early.

My rheumy is always looking for something worse.  He diagnosed Rheumatoid Arthritis when I met the criteria, but he has always suspected Lupus as well.  He started treatment immediately – as aggressively as I would let him.  I was in denial, and refused to believe I really had a serious disease.  He kept saying it was Mixed Connective Tissue Disease, and I thought that was a better thing that having Rheumatoid Arthritis.  I wasn’t really correct.

So what is Mixed Connective Tissue Disease?

Your body’s connective tissue is the structural tissue that holds your body together.  Connective tissue made of dozens of proteins, most commonly collagen and elastin.  Connective tissue surrounds many organs; cartilage, bone, blood, tendons and ligaments are specialised forms of connective tissue.  So you can easily see that when there’s a problem with your connective tissue, it can be serious, and affect your whole body.

MCTD  is a combination of several connective tissue diseases  – primarily Lupus,  Scleroderma, Polymyositis and sometimes Rheumatoid Arthritis.  In autoimmune diseases, many of the symptoms overlap.  A patient can meet most of the criteria for a disease, but not quite all.  I meet the criteria for RA, but not quite Lupus.  I have elements of many others.

I have the symmetrical joint inflammation of Rheumatoid Arthritis.  My hands and feet are affected, I am in constant pain.  I suffer fatigue, stiffness…all the usual symptoms.  RA usually affects the small joints (so they say) but most of my large joints are also affected.  Most of the joints in my body are inflamed and painful at some time.  It’s just that my hands, feet, knees, hips, shoulders and lower back are always painful.

I’m seronegative, so I also cross over into the seronegative spondyloarthropies.  My SI joints are alwasy inflamed, pointing to ankylosing spondylitis, or undifferentiated spondylitis, and my lumbar spine is pretty much shot, but that’s early onset osteoarthritis.  I believe this is from years of uncontrolled inflammatory arthritis, but its hard to say.

I have dry eyes and mouth.  My eyes get so dry that I need to put drops in regularly throughout the day. That would be Sjogren’s Syndrome.

But my arthritis is non-erosive.  I have very little damage visible on scans. This is great news…but it points toward Lupus, where joint pain (arthralgia) rather than swollen and inflamed joints is the main symptom.  Having said that, I do have impressive swelling some days…it’s just not always there.  So I fall between the cracks.  Then there are the other Lupus/SLE signs.  Raynaud’s Phenomenon.  Livedo Riticularis.  Kidney damage.  Muscle aches.  Fatigue.  Anemia.  A positive ANA – sometimes.  All of these things can also occur in Rheumatoid Arthritis too though..so it’s back to the criteria.

I don’t quite meet the criteria for Lupus.  So I don’t run around telling people that I have Lupus…even though my rheumy and 2 other rheumies also think this Lupus is probable.  I’m seeing a fourth rheumy in November.  If she also thinks Lupus, then maybe I’ll believe it.  But there is a big difference between a ‘suspicion’ and having a clinically diagnosed disease.  And ultimately, what does it matter?  The treatments are all the same.

Some people call this ‘rhupus’.  Maybe I’ll adopt that.  One more thing to explain…a conversation starter, a simplistic way to explain that autoimmune arthritis is not just occasional sore joints.  A way to educate and raise awareness.

I tell people that I have rheumatoid arthritis, not mixed connective tissue disease because at least most people have heard of rheumatoid arthritis, even if they have no idea that it’s a serious disease.

I’d probably get a lot more sympathy and support if I told people I have Lupus.  People do understand that Lupus is a serious disease.  What they don’t understand is that severe Rheumatoid Arthritis is very similar to Lupus.  It’s a systemic disease.  It causes organ damage.  It’s rare, but people do die from complications of rheumatoid arthritis.

It certainly disables.  It is certainly life limiting.  Rheumatoid Arthritis is certainly a serious disease.

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