DEAR DR. GOTT: Regarding your past columns about “growing pains,” I had such severe pain in my knees as a young teen that I could barely walk. I was told it was due to a growth spurt and to just learn to live with it. I had no fevers, redness or swelling, but just a few years later was hit with MCTD, including rheumatoid arthritis. I am happy that you told the child’s granny to look for other symptoms, such as fever, etc., but I think the pediatrician should have looked into doing some blood work to rule out other possibilities.
On another topic: For all those elderly people out there who have “fainting fits,” the “woozies” or the “spins,” drink a couple of glasses of water. My dad used to conk out for no apparent reason, and it usually turned out that he did not consume enough fluids and overused laxatives. We would get him to the ER and after IV hydration, he would snap out of it. Removal of laxatives from the house and closer monitoring of his fluid intake helped keep him on his feet.
DEAR READER: Mixed connective tissue disease (MCTD) is an uncommon autoimmune disorder, meaning that the body’s immune system attacks itself. It is sometimes referred to an as overlap disease because it causes symptoms similar to those associated with lupus, polymyositis, scleroderma and, sometimes, rheumatoid arthritis.
MCTD most often occurs in women in their 20s and 30s. Symptoms generally occur gradually with signs of lupus appearing first in most cases. Most sufferers are first diagnosed with lupus because of this, but as symptoms progress, the diagnosis of MCTD is then made.
Symptoms may include Raynaud’s disease (which may present years before other symptoms), malaise (feeling unwell), fatigue, mild fever, swollen joints and/or hands, puffy fingers, myalgia (muscle pain) and arthralgias (joint pain).
There is no cure, but treatment is available. Mild cases may not require treatment at all. Moderate to severe cases may need daily medication with non-steroidal anti-inflammatory drugs (NSAIDs), such as over-the-counter ibuprofen or naproxen sodium and prescription ibuprofen, oxaprozin and others. These work to reduce inflammation and pain. Methotrexate and corticosteroids, such as prednisone, may also be prescribed. These drugs work to suppress the immune system, thus reducing inflammation and pain. Other immunosuppressant drugs may be used if symptoms are more like one particular disorder, rather than an equal or near-equal combination of them. For example, those primarily with lupus-like symptoms may benefit from drugs used to treat lupus.
There are no known risk factors for developing MCTD, and there is no known cause. Complications of the disease and its treatment can include heart disease, pulmonary hypertension, possible pregnancy complications (studies currently conflict) and side effects of long-term corticosteroid use.
Now to your advice regarding fainting. Dehydration can be a serious problem, especially when combined with laxative overuse. This is especially true in the elderly who may already be on several medications and have other health concerns. Laxatives should only be used sparingly, if at all (unless directed by your doctor), because they can cause dehydration and dependence.
To provide related information, I am sending you copies of my Health Reports “Managing Chronic Pain” and “Constipation and Diarrhea.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.
