Positive RNP (MCTD)

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Regular Member

Date Joined Oct 2005
Total Posts : 251
   Posted 11/20/2008 5:57 PM (GMT -6)   
My Rheumy ran some bloodwork two weeks ago and my ANA has gone up and the Anti-RNP antibody is positive now.
Some may remember that we initially suspected I had Lupus because of a positive ANA (in 2005).  As my symptoms presented more, my Rheumy officially diagnosed RA (in 2006) even though I had no rheumatoid factor or CCP present.  I do always run a high CRP and ESR.  My main symptoms have always been joint pain and stiffness (no swelling), fever, malaise and fatigue.  I've developed other symptoms along the way.  I've also been diagnosed with Raynauld's and Sjogren's.
I guess my question is .......Do these antibodies have false positives?  Is it likely that I've had MCTD all along?
RA 3/06, Endometriosis 5/05, PCOS 1990
Meds: Metformin 1500mg (PCOS); Loestrin BCPs (Endo); Imuran 75mgs(RA); Metanx 5mg (RA); Humira (RA); Protonix (GERD)

Regular Member

Date Joined Oct 2005
Total Posts : 130
   Posted 11/21/2008 6:16 AM (GMT -6)   
MCTD is a classification category, like all 'diagnoses', meaning doctors have decided what they are going to call SLE or UCTD or MCTD etc. Not everybody fits into a neat classification box !
anti RNP is quite common in a number of autoimmune connective tissue diseases. It is very high levels that are usually a classification criteria for MCTD plus symptoms such as Raynaud's and sausage fingers and, classically, features of SLE, dermato/myositis and sceleroderma. Sometimes one might predominate or come to predominate.

In fact the nature of the disease you have, is the symptoms you are suffering. If the doctor thinks another CTD diagnosis is more appropriate than RA in any individual case he might want to change the treatment. Humira Enbrel and Remicaide aren't use much in SLE etc unless there's a strong RA component and no existing anti ds DNA, because they can cause anti ds DNA antibodies to occur. Or a doctor might want to add a disease modifying drug such as Plaquenil more often used in SLE and Sjogren's

It all depends on symptoms - what the patient reports, and signs - what the doctor observes. If your symptoms are not improved either, the appearance of the anti RNP or the rise in ANA might be seen as a need for more effective medication.
I thought RA was characterised by swollen joints ( and joint deformity) but it's possible I am quite wrong.
Of course, it's very bad from the insurance point of view to get an SLE diagnosis. In your place I'd be more concerned I was getting optimal treatment than what my condition might be called.


Regular Member

Date Joined Aug 2006
Total Posts : 142
   Posted 11/22/2008 3:44 AM (GMT -6)   
Its very possible. Since MCTD is just a mix of symptoms from different disorders. Usually when you have 2 dx (like RA and Sjogern's) thats what they call it. And most of the labs they test for are positive in most CTD. They all kind of cross over. And some can be positive even if you dont have anything. I know ANAs can be positive in people without symptoms, with RA, sjogerns, sclero, etc. Its something like 5% of the population has a positive ANA but only 1% of those have AI disease. I know I have heard that before, but not sure about the exact numbers.
Maybe you dont have RA and all you joint pains/stiffness/symptoms were caused by sjogerns, which would mean maybe you dont have MCTD either. RA may have been what your doc thought at the time. Now since more symptoms are showing she has a little more to go on she found the sjogerns. 
Its great to have name to go with all this crap but in another 5 years they might just call it something else anyhow! Sorry you are having so many frustrations with all the tests and diagnosis.Most of the connective tissue disorders have similar treatments and meds. Everyone responds differently to different meds, and will have different labs even with the same disease. Its great that you are getting treatment and thats whats important (as long as its helping!)
Take care
Dx: UCTD vs autoimmune spondyloarthropathy vs psoriatic arthritis (ie Limbo x5 yrs) Raynaud's, proteinuria
Rx: Plaquenil 400mg, Ultram PRN, Sulfasalazine 2 gram

Veteran Member

Date Joined Apr 2006
Total Posts : 1344
   Posted 11/22/2008 12:12 PM (GMT -6)   
I have MCTD which by definition is lupus, scleroderma and PM.  By their very nature AI diseases are very elusive and difficult to understand, diagnose and treat.  It is possible that you have had MCTD all along but it is also possible that your immune system has had new disruptions and your disease has morphed into a connective tissue disease.
It is not likely that you are getting false positives from your labs since you have already been diagnosed with lupus, RA and Sjogrens.  Secondary conditions like Raynuads and Gerds are common.
Do you have any muscle weakness?  Difficulty getting out of chairs, going up stairs, raising your hands over your head, or even swallowing? 
Most patients with MCTD exhibit some symptoms of myositis like I just described.  GERDs can be caused by myositis by weakening the spincter muscles at the top of the stomach.
MCTD is considered a separate disease that can have symptoms of all 3 diseases.  Every case is different and the range of severity is from mild to very severe like my case.  There has been a debate since 1972 over whether MCTD is a separate disease or not but it takes the presence of anti U1 RNP antibodies to make a diagnosis.  I had symptoms of lupus and polymyositis and possible internal scleroderma but that was never determined for sure even after several endoscopic exams and many biopsies.  I had severe joint pains for the first 5 months until prednisone relieved those pains.  Those symptoms could have been diagnosed as some form of arthritis by a less experienced doctor.
Hope you can get answers but the treatment for MCTD is similar to lupus and myositis (except IBM) diseases.  Do not ignore any increase in muscle weakness or swallowing problems as these symptoms are indicative of an active disease state and the need for a change of meds.
Mixed connective tissue disease (systemic lupus, scleroderma, polymyositis), Raynauds phenomena, Hypertension, Barrett's esophagus.
Meds: prednisone 5mg, 50mg imuran, Lotrel 40/5mg, maxide 37.5/25mg, folic acid, potassium, aciphex 20mg, multi vitamins.
Maintain your optimism and you can beat the odds.
"Although the world is full of suffering, it is also full of the overcoming of it."  Helen Keller

Regular Member

Date Joined Oct 2005
Total Posts : 251
   Posted 11/24/2008 4:45 PM (GMT -6)   
Thank you for the replies.  I wish A/I diseases were black and white....but unfortunately they are not!

Bill~I've had problems on and off with swallowing. My gastro stretched my esophagus earlier this year during an endoscopy. That has helped tremedously. I have noticed some muscle weakness, very mild though, and have dismissed it as lack of weight training/loss of muscle mass.

Imuran and Humira have help the joint pain and stiffness. I still will get the low grade fevers, most of the time in the evening.

RA 3/06, Endometriosis 5/05, PCOS 1990
Meds: Metformin 1500mg (PCOS); Loestrin BCPs (Endo); Imuran 75mgs(RA); Metanx 5mg (RA); Humira (RA); Protonix (GERD)

Regular Member

Date Joined Aug 2008
Total Posts : 431
   Posted 11/30/2008 4:57 AM (GMT -6)   

Hello Trying2bfree

So much good information was given to you in all of these posts.  the things that people said to you also helped me.  I didn't know that we needed to ignore muscle weakness.  After I say such things to my doctor and he does not speak to the symptom, I let it drop, thinking that this isn't something they need to know.

Thank you Bill for sending this website, and the info there.

Hope things will be better for you Trying2bfree.  this is what all of us are doing aren't we?  Trying to be free of disease, trying to be free of symptoms.  It is a good name that you gave to yourself.
Lupus diagnosed 1996, Heart by-pass 1998, breast cancer 2000, stroke2002, vascular surgery 2005, heart attack in 2007, and had a stint put in, Sjogren's Syndrome 2008
aspirin, multivitamin, Arthrotec , Meclazine ,  plaquinil, Metoclopomide, Doxepin , Metoprolol, synthroid,  Amlodipine, Crestor, Lasinopril, Plavix, phenagrin,  Restasis  

New Member

Date Joined Dec 2008
Total Posts : 7
   Posted 12/31/2008 10:16 PM (GMT -6)   
My ANA ran false positive for about 10 years. Although I had most of the symptons of Lupus I was never diagnosed. I've never had the face rash, although that doesn't have to be there. Have you been checked for fibromyalgia?

Regular Member

Date Joined Aug 2008
Total Posts : 431
   Posted 1/1/2009 11:40 AM (GMT -6)   
Hey Kwicker
Yes I have been examined for this and was diagnosed to be fibromyalgia.  but this doctor died.  He also diagnosed me for lupus.  the first blood test that I had taken for Lupus was done at the same time.  but the doctors I have now do not agree with Dr. Marlowe. 
I never had the face rash myself.  Red faced but not the butterfly rash.  But I have enough of the other symptoms to have a diagnoses of Lupus.  I wonder why Rheumatoloigist choose to not diagnose for Lupus.  they go out of their way to find some reason to diagnose that we have Lupus.  Even when he hears me say these symptoms that I have, he will still find a way to eliminate the diagnoses of Lupus.
I also apologize for being so long to post again to our group.  Just had some really awful depression, and that together with the pain, the nausea, the loss of energy and strength, and motivation, was getting through the day was hard.
but good days arrived again.  two wonderful days of pain free, and mentally capable, and then the pain started again.  I still have the mental capacity however.  I will try to do better posting than I have been doing.
Lupus diagnosed 1996, Fibromyalgia diagnosed 1996, Heart by-pass 1998, breast cancer 2000, stroke2002, vascular surgery 2005, heart attack in 2007, and had a stint put in, Sjogren's Syndrome 2008, Stroke 11-4-08
aspirin, multivitamin, Arthrotec , Meclazine ,  plaquinil, Metoclopomide, Doxepin , Metoprolol, synthroid,  Amlodipine, Crestor, Lasinopril, Plavix, phenagrin,  Restasis  

Veteran Member

Date Joined Sep 2005
Total Posts : 1744
   Posted 1/2/2009 9:48 AM (GMT -6)   

Hi Jeannie,

It looks like you have already received very good information.  MCTD is, in fact, a specific diagnostic category.  It is NOT the same thing as UCTD (undifferentiated CTD), and it is correlated with the RNP antibodies.  My mother had MCTD, but she didn't start with that diagnosis.  She started with RA, and then gradually added the rest.  As Bill pointed out, the typically MCTD is a mish mash of sx from PM, SSc, and SLE, although I've seen other combinations as well.  My rheumy, who claims to be an expert in MCTD, says that is his experience overlap CTDs are much more common than MCTD.  For example RA plus SLE (rhupus) is far more common that the PM, SSc and SLE combination.  Nevertheless, the antibodies sort of clinch the diagnosis from my understanding.  You cannot receive a diagnosis without those antibodies.  Remember, though, that it's the symptoms that need to be treated, and it sometimes doesn't matter what the symptoms are collectively called, as long as you are receiving proper treatment for the symptoms.  AI diseases are not easy to diagnose or treat.  We all do the best we can.



Current dx: Rheumatoid Arthritis
Suspected dx: UCTD/Early Lupus
Current Meds: Enbrel, Plaquenil, Methotrexate, nexium, tramadol, nasonex,Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan, zyrtec, zegerid, aciphex

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