DEAR DR. DONOHUE: I have been treated for a year for arthritis. Now my doctor tells me that I don’t have arthritis but that I have mixed connective tissue disease. How could the doctor have been so wrong about the diagnosis for so long? Does the delay affect my chances for recovery? – R.V.

ANSWER: Mixed connective tissue disease (MCT) is easily mistaken for rheumatoid arthritis because they share many common signs and symptoms. It is a form of arthritis.

Connective tissues are the body’s support, its scaffolding and its packing material. Ligaments, tendons, cartilage, bones, joints and skin are some of the connective tissues. Collagen, a sturdy protein, is a component of most connective tissues.

The connective tissue diseases include rheumatoid arthritis, lupus, scleroderma (a hardening of skin and internal organs) and polymyositis (muscle inflammation and weakness). Each of these illnesses has distinctive features, and they usually can be distinguished from one another without trouble. Mixed connective tissue disease, on the other hand, borrows signs and symptoms from the others, and that can lead to confusion about its true nature.

Raynaud’s phenomenon is a common sign of MCT. When the hands (or feet) are exposed to cold, blood vessels to the hand and fingers constrict violently so no blood reaches those destinations. The skin of the fingers blanches. As the constriction continues, the skin turns blue because the blood trapped in the constricted vessels gives up its oxygen. Finally, when the constriction relaxes, a surge of blood into the hands and fingers turns them bright red.

The delay in making your diagnosis won’t affect its course. Your symptoms have remained the same – a good omen. Your outlook is likely to be favorable, as is the outlook for more than half of MCT patients.

The arthritis and lupus pamphlet gives an overview of the nature and treatment of these two connective tissue diseases. Readers can obtain a copy by writing: Dr. Donohue – No. 301, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: On March 10, our 4-year-old daughter woke up with a rash and sore throat. The doctor said it was scarlet fever. Within a few days she was transferred to a large hospital and put in the burn unit. She had toxic epidermal necrolysis. Her skin would slough off. She kept getting worse and was put on life support. Within six days from her admission, my daughter died. This disease has many conflicting facts. Please pass this information on to your readers and add anything you can. – D.K.

ANSWER: Three illnesses where skin is the chief target are erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis. They are somehow related, and the last one is the worst.

More than 100 different medicines as well as a number of bacteria and viruses have been identified as switches that turn on the immune system and lead to the series of events your daughter endured.

Toxic epidermal necrolysis is managed like a severe burn, and your daughter’s doctors treated her by the book by putting her in the burn unit. Even with the most up-to-date and meticulous care, it often proves fatal.

I have no words to comfort you in this tragedy. I am certain all readers feel the same.

DEAR DR. DONOHUE: I was told by a dermatologist that I have a bacterial nail infection, but not a fungal infection. The nail turns green. The doctor prescribed gentamicin ointment, but I don’t use it regularly, since it is so messy. I happen to be a chronic hand-washer, which doesn’t help. Your opinion would be appreciated. – J.S.

ANSWER: The pseudomonas (SUE-duh-MOAN-us) bacterium can infect nails and turn them green. It is a very tough germ to obliterate. Your ointment gentamicin is the one most successful in eliminating this germ, but treatment might have to go on for a full year. And it must be applied as directed.

Your hand-washing is not helping matters. Have you sought any treatment for it? It can disrupt your life more than the nail infection does. Your family doctor can provide you with the name of a therapist.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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