Medicine

Treatment of MCTD is directed at suppressing immune-related inflammation of tissues and is similar to treatment for lupus. Corticosteroids (for example, prednisone) are usually effective, especially when the disease is diagnosed early. Mild cases can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), hydroxychloroquine or similar drugs, and low doses of corticosteroids.
 
The more severe the disease, the higher the dose of corticosteroid needed. Prednisone is the most common corticosteroid used and is taken in pill form. Prednisone is usually considered when the symptoms of MCTD are not being controlled by other treatments.
 
Prednisone use needs to be carefully monitored because of its many side effects, and the drug must never be stopped abruptly. Some of the side effects from long-term use include cataracts, high blood pressure, sleep problems, muscle loss, bruising, thinning of the bones (osteoporosis), weight gain and increased risk of infections. The goal with this and most drugs is to find the lowest effective dose to avoid as many of the side effects as possible.
In severe cases of MCTD, immunosuppressive drugs (e.g. cytotoxic drugs) may also be needed. These drugs are powerful medications that suppress inflammation and the immune system. You may be prescribed these if your MCTD symptoms are difficult to control with prednisone alone or if you are experiencing side effects from prednisone.
 
Cyclophosphamide (Procytox) and Imuran (azathioprine) are commonly prescribed immunosuppressant drugs. Serious side effects from these drugs include decreased blood cell counts, increased risk of infection, and a risk of developing certain types of cancer. People taking these medications must have regular blood tests and be monitored very closely by their doctor.
 
In general, the more advanced the disease and the greater the organ damage, the less effective the treatment will be. Scleroderma-like damage to the skin and esophagus (pronounced e-sof-a-gus) is least likely to respond to treatment. Symptom-free periods can sometimes last for many years through minimal or no ongoing treatment. However, MCTD will progress in spite of treatment in about 13 percent of cases.

A Word about Medication Safety
The need to effectively monitor new drugs once they have been approved and introduced into the market has been a key advocacy issue for The Arthritis Society for several years. This advocacy helps to ensure that unfavorable side effects are reported, documented, and addressed. For regular updates on medications available in Canada, visit www.arthritis.ca/tips/medications.

All medications have potential side effects whether they are taken by themselves or in combination with other herbal, over-the-counter and prescription medications. It is therefore important for patients to discuss the benefits and potential side effects of all their medications with their doctor.

Health Canada’s Marketed Health Products Directorate (MHPD) has recently developed a new website, named MedEffect. MedEffect’s goal is to provide centralized access to new safety information about health products in an easy to find, easy to remember location. It also aims to make it as simple and efficient as possible for health professionals and consumers to complete and submit adverse reaction reports. Finally, it helps to build awareness about the importance of submitting adverse reaction reports to identify and communicate potential risks associated with certain drugs or health products. To find out more, visit: www.healthcanada.gc.ca/medeffect or call toll-free 1-866-234-2345.

Along with the physical symptoms of MCTD, many people experience feelings of helplessness and depression. Learning daily living strategies to manage your arthritis gives you a greater feeling of control and a more positive outlook. To get the best results, people affected by arthritis need to form close ties with their doctors and therapists, and become full partners in their treatment. From our perspective, it's all part of 'living well with arthritis.' There are several resources you can use in finding out how best to manage your own arthritis. Here are a few:

• The Arthritis Self-Management Program (ASMP) is a unique self-help program offered by The Arthritis Society to help you better control and manage your arthritis
• The Open Forum within this website is an opportunity to discuss and share information with other visitors - people who, through their own experiences, may be able to offer some useful insights.

Of course, there are many other valuable resources for people with arthritis. If you're unclear about where to look for help, be sure to call The Arthritis Society at 1-800-321-1433.