questiong my diagnosis | Arthritis Information

 

Ok so Liz and I talked for a long time last night and she made me realize something I dont want to admit...my RA is NOT controlled like my RD *says* it is.  I still have to take pain meds regularly....She said why am I using a bandaid on this?   So...this made me REALLY think...And well when that happnes it gets me into trouble LOL....So I went to see what the signs are for lupus.   Since many of the symptoms of lupus are the same as RA how are we diagnosed with a FOR SURE diagnosis of RA rather then lupus?  Do you HAVE to have the butterfly rash for it to be Lupus?  How long does this rash stay?  Is it always on your face or does it come and go?   I dont know if anyone has the answers for me or not but I just wanted to throw what Im thinking out there just in case.

Oh... you don't have to have the malar rash to have lupus. Its like RA, everyone experiences it differently. Depending on what comes first, you can have both. If RA is the primary diagnosis, there is a slight chance that you can have lupus as well, but if lupus is the primary diagnosis, you can have a 1 in 10 chance of getting RA as well. Of course, once you get an AI disease, you are likely to get another, so pfft. Can't say! The major thing in separating RA from SLE is that there is generally joint damage in RA. Unless you are my grandmother who has mild seronegative non-erosive RA, then you are lucky. Ask your RD to do some diagnostic tests for lupus. Then you'll know. Hopefully. _popupControl(); I'm no expert but my SIL has lupus and she doesn't have the butterfly rash and she is being treated with prednisone and plaquinel (I know I didn't spell that right, lol). I do believe there is something detected (I can't remember what it is) in your blood that determines it is lupus. So I wonder if they treat Lupus and RA pretty much the same. My RD did blood work for lupus called a Lupus Anticoagulant Evaluation.  It consisted of a lupus sreen, a PTT (LAC) screen and a DRVVT screen.   I also seem to remember reading that lupus can be confirmed by the pattern found within an ANA titer blood test.  Speckled is one pattern, but that one is not definitive for lupus.  I'm sure someone here with more lupus knowledge will be able to fill you in.   Yea I am going to call my RD and see if he'll talk w/ me over the phone (via his nurse of course* and send a blood work thing over before I get my blood work done for when I see him in May and include something for lupus as well as the normal stuff.  Has anyone heard of being put on plaquinel in addition to the Humira and Mtx all at the same time?   Initially when I was first diagnosed w/ RA I was stero-positive but the last few years or so I have been stero-negative and from what I can remember any of my MRI's, bone scans, x-rays Ive had throughout the years (I *should* be glowing w/ the amount I have had) have never shown any erosion..... Plaquenil is apparently a wonderful drug for lupus! I'm on it for RA, its the starter DMARD because it causes less toxicity than the others but most don't stay on it because it is quite mild. I've found it helps with fatigue, which is a big problem for me, so I will keep on it when trying out the other DMARDs. Positive ANA, Anti-Sm, anti ds DNA, anti-ENA, anti-PA and a false positive for syphillis can detect lupus in your blood. RF isn't really a reliable diagnostic indicator for RA coz you can have it in heaps of other diseases, but generally if you have at least 4 of the 7 other diagnostic criteria, as well as a positive RF you *probably* have RA.

I forgot to add: the meds that you are on can cause lupus-like symptoms. _popupControl(); _popupControl(); paperdoll2008-03-24 06:00:10Paperdoll, what are the 7 diagnostic criteria for RA?? ^ Its on Wikipedia, my love.
But I'll post it here...

http://en.wikipedia.org/wiki/Rheumatoid_arthritis#Diagnosis

• Morning stiffness of >1 hour most mornings for at least 6 weeks.
• Arthritis and soft-tissue swelling of >3 of 14 joints/joint groups, present for at least 6 weeks
• Arthritis of hand joints, present for at least 6 weeks
• Symmetric arthritis, present for at least 6 weeks
• Subcutaneous nodules in specific places
• Rheumatoid factor at a level above the 95th percentile
• Radiological changes suggestive of joint erosion

At least four criteria have to be met for classification as RA.

And SLE:

http://en.wikipedia.org/wiki/Systemic_lupus_erythematosus#Diagnostic_criteria

Patients must meet the following three criteria to be classified as having SLE: (i) patient must present with four of the below eleven symptoms (ii) either simultaneously or serially (iii) during a given period of observation.

1. Serositis: Pleuritis (inflammation of the membrane around the lungs) or pericarditis (inflammation of the membrane around the heart)sensitivity = 56%; specificity = 86% (pleural is more sensitive; cardiac is more specific)^[19]
2. Oral ulcers: include oral or nasopharyngeal ulcers
3. Arthritis: nonerosive arthritis of two or more peripheral joints, with tenderness, swelling or effusionsensitivity = 86%; specificity = 37%^[19]
4. Photosensitivity (exposure to ultraviolet light causes rash). sensitivity = 43%; specificity = 96%^[19]
5. Hematologic disorder: Hemolytic anemia (low red blood cell count) or leukopenia (white blood cell count<4000/ul), lymphopenia ( <1500/ul ) or thrombocytopenia (<100000/uL) in the absence of offending drug.sensitivity = 59%; specificity = 89%^[19] Hypocomplementemia is also seen, due to either consumption of C3 and C4 by immune complex-induced inflammation, or to congenitally complement deficiency, which may predispose to SLE.
6. Renal disorder: More than 0.5 g per day protein in urine, or cellular casts seen in urine under a microscope.sensitivity = 51%; specificity = 94%^[19]
7. Anti-nuclear antibody test positive. sensitivity = 99%; specificity = 49%^[19]
8. Immunologic disorder: Positive anti-Sm, anti-ds DNA, anti-phospholipid antibody and/or false positive serological test for syphilis. sensitivity = 85%; specificity = 93%^[19]. Presence of anti-ss DNA in 70% of patients (though also positive in patients with rheumatic disease and healthy persons^[20])
9. Neurologic disorder: Seizures or psychosis. sensitivity = 20%; specificity = 98%^[19]
10. Malar rash (rash on cheeks). sensitivity = 57%; specificity = 96%^[19]
11. Discoid lupus (red, scaly patches on skin which cause scarring) sensitivity = 18%; specificity = 99%^[19]

As I was saying before, MTX, Humira and Pred can cause these symptoms as well. Oral ulcers (Pred, MTX and Humira), Serositis (which happens in RA as well and on MTX), Photosensitivity (Pred makes me burn), Hemotologic disorder (which you get tested for on MTX), as well as renal disorder (white blood cells in urine caused by inflammation) can all happen _popupControl(); on your meds.
paperdoll2008-03-24 07:37:49Thank you!

Shannon; What symptoms are you having that make you suspect Lupus?

Lovie, the symptoms I am having are those that mirror RA, I also have had protien in my urine and get the butterfly rash occasionally as well. I don't really understand the cc's verses mg but that doesn't sound like much. Maybe you can take plaqunil too.

.1 cc equals 1 2.5 mg tablet...So I am taking 12.5mgs...Yea when I see my RD again in a month I am going to ask him about adding Plaquinil again. I was on it when i was first diagnosed so we'll see.

The way it was explained to me, the ANA test  is the main means of diagnosing lupus.  If it comes back positive, it does not mean you definitely have Lupus, as RA and other conditions can cause a false positive, however, if the ANA test comes back negative, it is a definite negative - you don't have lupus. Aww Shanna Banana.

If you have Lupus you better not leave us cause we don't have Lupus like you.


I'll beat you with a stick. *grin*
Kelsey'sMommy--I take Remicade, MTX, and Plaquenil.  I have Sjogren's in addition to the RA so I think the Plaquenil helps w/that.  I've been on plaq for about 9 years now...i've read the combo of these meds are what makes them work.  separately they are not as effective.  hope your doc agrees to add the plaq as I think it's a good med with no side effects.  best regards, Molly BeeLovie, I *think* I have had an ANA test done, i just have to find my blood work....if not i'll call the dr and have them pull my records to tell me

Lala, no that wasnt confusing at atll!! That was acually clearer then anything I have read online so far!! Thank you!!

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