Rheumatology International

, Volume 29, Issue 6, pp 685–688 | Cite as

A case of MCTD overlapped by Takayasu’s arteritis, presenting Raynaud’s phenomenon as the initial manifestation of both diseases

  • Mie Jin Lim
  • Seong Ryul Kwon
  • Sang Gu Kim
  • Won Park
Case Report
First Online:
Received:
Accepted:

Abstract

Raynaud’s phenomenon is characteristic three-phase color change of digits that occurs when hands are exposed to cold and subsequently rewarmed. Raynaud’s phenomenon has many possible causes, but evaluation tends to focus on a few notorious etiologies, such as, connective tissue diseases. Thus, having reached a diagnosis, detailed physical exam to rule out other possible causes is often not performed. The authors present a case of mixed connective tissue disease (MCTD) and Takayasu’s arteritis overlap in a woman, who showed Raynaud’s phenomenon as an initial manifestation. She was first diagnosed as having MCTD, but her treatment did not improve the persistent Raynaud’s phenomenon. Several years later, follow-up chest CT showed underlying Takayasu’s arteritis and a subsequent physical examination revealed that typical abnormalities consistent with Takayasu’s arteritis were present. The authors advocate thorough history taking and complete physical examinations on a routine basis to help unearth other underlying causes.

Keywords

Raynaud’s phenomenon Mixed connective tissue disease Takayasu’s arteritis 
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Coffman JD (1989) Raynaud’s phenomenon. Oxford University Press, New YorkGoogle Scholar
  2. 2.
    Wigley FM (2002) Clinical practice. Raynaud’s Phenomenon. N Engl J Med 347(13):1001–1008. doi: 10.1056/NEJMcp013013 PubMedCrossRefGoogle Scholar
  3. 3.
    Gayraud M (2007) Raynaud’s phenomenon. Joint Bone Spine 74(1):e1–e8. doi: 10.1016/j.jbspin.2006.07.002 PubMedCrossRefGoogle Scholar
  4. 4.
    Kasukawa R, Tojo T, Miyawaki S (1987) Preliminary diagnostic criteria for classification of mixed connective tissue disease. In: Kasukawa R, Sharp GC (eds) Mixed connective tissue diseases and antinuclear antibodies. Elsevier, Amsterdam, pp 41–47Google Scholar
  5. 5.
    Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM et al (1990) The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 33(8):1129–1134PubMedGoogle Scholar
  6. 6.
    Sharp GC, Irvin WS, Em Tan et al (1972) Mixed connective tissue disease: an apparently distinct rheumatic disease syndrome associated with a specific antibody to an extractable nuclear antigen (ENA). Am J Med 52:148–159. doi: 10.1016/0002-9343(72)90064-2 PubMedCrossRefGoogle Scholar
  7. 7.
    Sharp GC (1987) Diagnostic criteria for classification of MCTD. In: Kasukawa R, Sharp G (eds) Mixed connective tissue disease and antinuclear antibodies. Elsevier, Amsterdam, pp 23–32Google Scholar
  8. 8.
    Kahn MF, Appelboom T (1991) Syndrome de Sharp. In: Kahn MF, Peltier AP, Meyer O, Piette JC (eds) Les Maladies Systemiques. Flammarion, Paris, pp 545–556Google Scholar
  9. 9.
    Alarcon-Segovia D, Villareal M (1987) Classification and diagnostic criteria for mixed connective tissue disease. In: Kasukawa R, Sharp G (eds) Mixed connective tissue disease and antinuclear antibodies. Elsevier, Amsterdam, pp 33–40Google Scholar
  10. 10.
    Grader-Beck T, Wigley FM (2005) Raynaud’s phenomenon in mixed connective tissue disease. Rheum Dis Clin North Am 31(3):465–481. doi: 10.1016/j.rdc.2005.04.006 PubMedCrossRefGoogle Scholar
  11. 11.
    Bennet RM (2005) Mixed connective tissue disease and other overlap syndromes. In: Harris ED, Budd RC, Genovese MC, Firestein GS, Sargent JS, Sledge CB Kelly’s (eds) Textbook of rheumatology, 7th edn. Elsevier Saunders, Philadelphia, pp 1258–1272Google Scholar
  12. 12.
    Venables P (2003) Overlap syndrome. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH (eds) Rheumatology, 3rd edn. Mosby, Philadelphia, pp 1573–1577Google Scholar
  13. 13.
    Numano F, Okawara M, Inomata H, Kobayashi Y (2003) Takayasu’s arteritis. Lancet 356(9234):1023–1025. doi: 10.1016/S0140-6736(00)02701-X CrossRefGoogle Scholar
  14. 14.
    Weyand CM, Goronzy JJ (2008) Vasculitides A. Giant cell arteritis, polymylaiga rheumatica, and Takayasu’s arteritis. In: Klippel JH, Stone JH, Crofford LJ, White PH (eds) Primer on the rheumatic diseases, 13th edn. Springer, New York, pp 406–408Google Scholar
  15. 15.
    Francès C, Boisnic S, Blétry O, Dallot A, Thomas D, Kieffer E et al (1990) Cutaneous manifestations of Takayasu. arteritis A retrospective study of 80 cases. Dermatologica 181(4):266–272PubMedCrossRefGoogle Scholar
  16. 16.
    Shelhamer JH, Volkman DJ, Parrillo JE, Lawley TJ, Johnston MR, Fauci AS (1985) Takayasu’s arteritis and its therapy. Ann Intern Med 103:121–126PubMedGoogle Scholar
  17. 17.
    Spencer-Green G (1998) Outcomes in primary Raynaud phenomenon: a meta-analysis of the frequency, rates and predictors of transition to secondary disease. Arch Intern Med 158:595–600. doi: 10.1001/archinte.158.6.595 PubMedCrossRefGoogle Scholar
  18. 18.
    Flavahan NA, Flavahan S, Mitra S, Chotani MA (2003) The vasculopathy of Raynaud’s phenomenon and scleroderma. Rheum Dis Clin North Am 29:275–291. doi: 10.1016/S0889-857X(03)00021-8 PubMedCrossRefGoogle Scholar
  19. 19.
    Tato F, Rieger J, Hoffmann U (2005) Refractory Takayasu’s arteritis successfully treated with the human, monoclonal anti-tumor necrosis factor antibody adalimumab. Int Angiol 24(3):304–307PubMedGoogle Scholar
  20. 20.
    Pope JE (2002) Scleroderma overlap syndromes. Curr Opin Rheumatol 14(6):704–710. doi: 10.1097/00002281-200211000-00013 PubMedCrossRefGoogle Scholar
  21. 21.
    Kim TJ, Uhm WS, Song SY, Jun JB (2007) Unilateral weak radial pulse in a patient with systemic sclerosis: Takayasu’s arteritis or thoracic outlet syndrome? Rheumatol Int 27(8):789–790. doi: 10.1007/s00296-006-0292-3 PubMedCrossRefGoogle Scholar
  22. 22.
    Passiu G, Vacca A, Sanna G, Cauli A, Laudadio M, Garau P et al (1999) Takayasu’s arteritis overlapping with systemic sclerosis. Clin Exp Rheumatol 17(3):363–365PubMedGoogle Scholar
  23. 23.
    Yago T, Ota S, Nishinarita M (2002) A case of systemic sclerosis complicated by Takayasu’s arteritis. Ryumachi 42(3):605–609PubMedGoogle Scholar
  24. 24.
    Kocabay G, Tiryaki B, Ekmekçi A, Inanç M (2006) Takayasu arteritis associated with systemic sclerosis. Mod Rheumatol 16(2):120–121. doi: 10.1007/s10165-006-0459-5 PubMedCrossRefGoogle Scholar
  25. 25.
    Zlatkin S, Aamar S, Specter G, Leibowitz D, Simanovsky N, Yeshurun D et al (1999) Takayasu’s arteritis identified by computerized tomography: revealing the submerged portion of the iceberg? Isr Med Assoc J 1(4):245–249PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Mie Jin Lim
    • 1
  • Seong Ryul Kwon
    • 1
  • Sang Gu Kim
    • 1
  • Won Park
    • 1
  1. 1.Inha University HospitalIncheonSouth Korea

Personalised recommendations