Which physical findings are characteristic of mixed connective-tissue disorder (MCTD)?

Updated: Oct 01, 2018
  • Author: Eric L Greidinger, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Physical examination is helpful in confirming or identifying features of MCTD. Seek the following features on examination:

  • Fever should prompt a careful search for infection; however, infection may be present in the absence of fever and is one of the primary disease-related causes of mortality and/or morbidity in MCTD; the use of corticosteroids and immunosuppressive agents further increases the risk of infection [20]
  • Corticosteroids may mask serious intra-abdominal processes, including appendicitis, vasculitis, pancreatitis, and bowel perforation
  • Cardiopulmonary symptoms or findings should prompt a careful evaluation for pulmonary hypertension
  • Capillary microscopy can assist in finding sclerodermatous-type nailfold changes
  • Severe Raynaud phenomenon may result in digital vascular infarcts and ulcerations
  • Pericarditis may be occult and can progress rapidly to cardiac tamponade
  • Trigeminal neuralgia is common in MCTD
  • Secondary Sjögren syndrome occurs in 25% of patients with MCTD and may cause both ocular symptoms and oral dryness

Protein-losing gastroenteropathy is a rare feature of MCTD, but may be the initial manifestation of the disorder. Patients present with generalized edema, ascites, and pleural and pericardial effusions due to to hypoproteinemia from leakage of serum protein into the gastrointestinal tract. [21]


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