sigmadx
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Sup everyone. I'm a longtime reader and first time poster now that I'm finally in med school heh. Anyways, here we go:
A 37-year-old woman with Raynaud’s phenomenon complains of progressive weakness with inability to arise out of a sitting position without assistance. On examination, the patient has swollen “sausage-like” fingers, alopecia, erythematous patches on the knuckles, facial telangiectasias, and proximal muscle weakness.
Laboratory evaluation includes a normal CBC and serum chemistries, except for
creatine phosphokinase, 4.5 kat/L (270 U/L),
and aldolase, 500 nkat/L (30 U/L).
The following serologic profile is found: rheumatoid factor is positive at 1:1600; ANA is also positive at 1:1600 with a speckled pattern and very high titers of antibodies against the ribonuclease-sensitive ribonucleoprotein component of extractable nuclear antigen.
This patient probably has
(A) early rheumatoid arthritis
(B) systemic sclerosis
(C) systemic lupus erythematosus
(D) dermatomyositis
(E) mixed connective-tissue disease (MCTD)
Edited by new_n_lost on 11/14/07 - 12:12 AM. Reason: Edited the format of the question
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| new_n_lost
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(E) mixed connective-tissue disease (MCTD) : Looking at the labs i get more tilted towards it cos of the presence of RNP antiboides which is quote specific for MCTD.
Any other comments ??
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| silver
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why not SLE?
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| new_n_lost
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silver wrote:
why not SLE?
Just for Discussion :- Y SLE ??
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| silver
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well nnl was mixing up the 2...yes you are right...it should be MCTD...differentiating factor being +anti-rp for MCTD and +anti-ds DNA or anti-smooth muscle antibodies for SLE
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| sigmadx
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Sorry for the late response, I went to sleep  .
The answer is E. MCTD is a syndrome characterized by high titers of
circulating antibodies to the ribonucleoprotein component of extractable nuclear antigen
in association with clinical features similar to those of SLE, systemic sclerosis, polymyositis,
and rheumatoid arthritis. The average patient with MCTD is a middle-aged woman
with Raynaud’s phenomenon who also has polyarthritis, sclerodactyly (including swollen
hands), esophageal dysfunction, pulmonary fibrosis, and inflammatory myopathy. Cutaneous manifestations include telangiectasias on the face and hands, alopecia, a lupuslike heliotropic rash, and erythematous patches over the knuckles. Myopathy may involve severe weakness of proximal muscles associated with high levels of creatine phosphokinase and aldolase. Both pulmonary involvement and esophageal dysmotility are common but are frequently asymptomatic until quite advanced. Almost all patients have high titers of rheumatoid factor and antinuclear antibodies. Such antibodies are directed toward the ribonuclease-sensitive ribonucleoprotein component of extractable nuclear antigen.
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| SmokyWaters
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yes MCTD wud be my choice...it has features of SLE, SS and PM all together further more...the anit Jo antibody and antibodies against U1 RNP are present in 100% of the cases
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| new_n_lost
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sigmadx wrote:Sorry for the late response, I went to sleep .
Nah its alright normally do us ppl a day to repsond to ur question cos ppl from different parts of the world have different timings so its best to wait for a day or so.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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