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How is mixed connective tissue disease (MCTD) diagnosed and treated?

Q: My 44-year-old relative is suffering from the disease called Mixed Connective Tissue Disease (MCTD) for the past 3 years. Her weight is continuously dropping. She also has problems in her lungs and eyes. She frequently catches fever along with joint and muscle pain. She is presently being given steroid based medication due to which she has several side effects like cataract. What is the latest medication available to keep the disease in remission permanently or at least for years together? Please send me the contact details of Rheumatologists in Mumbai. Several books are available on the internet, which claim that simple treatments of Lupus have been discovered. Are such information and claims authentic or simply fraud? Can Ayurveda or Homoeopathy treat Lupus and Mixed Connective Tissue Disease?

A:The diagnosis of MCTD is a tricky issue. It can only be made by experienced rheumatologists specially trained in connective tissue diseases. There are 3 different international criteria with some confusion over which one is the most sensitive and which one is most specific for this syndrome. This necessary to mention this fact because the diagnosis must be very accurate before management of the condition can be planned. One of the crucial part of making a definite diagnosis is to get anti-U1-RNP antibody test done. The diagnosis can be made only in the presence of high titres of this anti body. I hope these facts have been taken in account while labelling your disease as MCTD. Once the issue of diagnosis is settled, the next point would be to carefully assess the exact extent and the degree of target organ involvement. This is mandatory because treatment depends upon this fact. One of the important issues is the presence or absence of pulmonary hypertension. This is extremely important as this decides the prognosis of the disease. Basically, the treatment is symptomatic and depends upon the target organ involvement, as mentioned above. As you would appreciate, details of treatment cannot be given in this e-mail message as it is quite complicated. Regarding your third point related to ‘Ayurvedic treatment’, not having any knowledge of this field, I would not be able to given you any opinion on Ayurvedic treatment. In Mumbai the rheumatologists are as follows: Dr. Balakrishnan in Hinduja Hospital Dr. Sanjiv Amin in Bombay Hospital Dr. P. K. Pispati in Jaslok Hospital

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