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General Rheumatology

Understanding the Lupus and MCTD Connection

May 26, 2025 ·

Learn the key differences between lupus and MCTD, from Raynaud’s phenomenon to the RNP antibody, and why the distinction matters.

When you’re living with lupus, it can feel like every symptom and test is part of the same story. But what happens when new clues emerge, pointing toward a different diagnosis like Mixed Connective Tissue Disorder (MCTD)? Let’s break down the differences, key markers, and why it all matters for your care.

Read more: Understanding the Lupus and MCTD Connection

What Are Lupus and MCTD?

Lupus and MCTD are both systemic autoimmune diseases that cause inflammation throughout the body. They share overlapping symptoms like fatigue, joint pain, rashes, and even a positive ANA (antinuclear antibody) test.

MCTD, however, is what rheumatologists call an “overlap condition.” This means it combines features of lupus, scleroderma, and myositis, creating its own distinct condition. The trick is spotting the subtle differences that suggest it’s not “just lupus.”

Raynaud’s Phenomenon: A Clue to Look Deeper

Raynaud’s phenomenon—where fingers or toes turn white, blue, then red in response to cold or stress—is common in lupus. But when combined with other signs like skin tightening, it raises a red flag for MCTD.

Raynaud’s is also associated with scleroderma, a condition that’s part of the MCTD overlap. If you notice color changes in your fingers or toes, don’t dismiss it as “normal.” It might be a critical clue.

The Role of the RNP Antibody

If your doctor is digging deeper into an autoimmune diagnosis, they’ll often check your antibodies. One of the most important markers for MCTD is the RNP antibody, also called Sm/RNP or U1RNP.

A high RNP antibody level is like a neon sign pointing to MCTD. While lupus can sometimes present with this antibody, its strong presence should encourage doctors to evaluate for features of MCTD like muscle inflammation or fibrosis.

Muscle Inflammation and Skin Tightening

Symptoms like muscle weakness—difficulty combing your hair or climbing stairs—are more common in MCTD. This weakness stems from inflammation in the muscles, something not typically seen in lupus.

Skin tightening is another key difference. If you notice the skin around your fingers, hands, or forearms feels tighter or looks shiny, it’s worth mentioning. These changes point to the scleroderma component of MCTD and are rarely seen in lupus alone.

Why Diagnosis Matters

You might wonder: if the treatments for lupus and MCTD overlap, why does the distinction matter? The answer lies in the complications.

MCTD carries a higher risk of fibrosis—thickening and scarring—in the lungs or esophagus. These complications require different monitoring and treatment strategies than lupus. Knowing you have MCTD allows your doctor to anticipate and manage these risks early.

What Can You Do?

Autoimmune diseases are dynamic, and symptoms can evolve over time. If you’ve been diagnosed with lupus but notice new symptoms like Raynaud’s, muscle weakness, or skin tightening, don’t assume they’re part of the same story.

Discuss your concerns with your doctor and ask about the RNP antibody. It’s a small step that could lead to big insights into your health.

Dr. Elizabeth Ortiz, double board certified Rheumatologist

Spotting RA in Your Hands

April 14, 2025 ·

hand osteoarthritis is very different than rheumatoid arthritis

Hand pain can be frustrating and confusing, especially when it starts to interfere with daily life. You may wonder: is it just part of getting older, or could it be something more serious like rheumatoid arthritis (RA)? While osteoarthritis (OA) and RA can both affect your hands, they’re very different conditions with different treatments. Let’s dive into the key signs that can help you understand what’s causing your hand pain.

[Read more…] about Spotting RA in Your Hands

Can you have ANA negative lupus?

March 10, 2025 ·

if your ANA is negative, it can difficult to know if you have systemic lupus erythematosus (SLE)

Getting an autoimmune diagnosis like lupus is a life-changing event. But what we don’t talk about enough is how life-changing the journey to that diagnosis can be. For many, it’s a rollercoaster of confusing symptoms, endless doctor visits, and—often—conflicting test results. One of the most common points of confusion? The ANA test, its results, and what they actually mean when you’re trying to figure out if you have lupus.

Let’s dive into the complexities of the ANA test, what it means for lupus, and why focusing on your symptoms might be the key to getting the answers you need.

[Read more…] about Can you have ANA negative lupus?

Exercise for Fibromyalgia: How to Start

March 3, 2025 ·

Exercising with fibromyalgia can help with body pain.

Living with fibromyalgia can feel like your body has turned against you. Pain, fatigue, and unpredictability can make even the idea of exercise overwhelming. If this sounds familiar, you’re not alone. Many of my patients with fibromyalgia feel the same way, especially if they’re worried about triggering a flare or feel like they’ve lost the ability to move the way they used to.

But here’s the truth: exercise is not just helpful—it’s essential for managing fibromyalgia. Let’s break down why movement matters, how it can actually help your symptoms, and, most importantly, how to get started in a way that feels doable.

[Read more…] about Exercise for Fibromyalgia: How to Start

What to consider when facing a biologic

February 24, 2025 ·

Starting a biologic for rheumatoid arthritis is a big step

Talking about changes to our autoimmune treatment can be overwhelming—especially if the conversation turns to biologics. Many people managing rheumatoid arthritis (RA) or other autoimmune diseases find themselves in a rheumatologist’s office, hearing that a biologic might be the next best step. So, what exactly are biologics, and how can you make the best decision for yourself? Let’s dive into the basics and explore some key questions to ask so you can feel more comfortable with whatever path you choose.

What Are Biologics?

Biologics are a class of medications that have brought a whole new level of specificity to autoimmune treatment. Unlike traditional drugs, biologics are made from living organisms—proteins, antibodies, or cells—which scientists isolate and modify to target specific aspects of the immune system. For people with autoimmune diseases, these medications can help reduce inflammation and limit the immune system’s overactivity that causes joint damage.

[Read more…] about What to consider when facing a biologic
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