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Answers tagged lupus: Page 1 of 1
Q:

Travis from Calgary asks: Do rheumatologists treat Raynaud’s phenomenon?

Raynaud’s is a condition where upon exposure to cold, the peripheral parts of the body – fingers and toes, but sometimes nose or ears – can become painful and change colours from white to blue to red.  It is certainly a condition that rheumatologists may see. Raynaud’s can occur in individuals “just because”, often starting as a young adult.  It can also happen in association with other rheumatic diseases, including rheumatoid arthritis, lupus, and scleroderma.  A rheumatologist can assess a person for Raynaud’s, make suggestions to help, and also ensure the person does not have any underlying rheumatic disease too.

Q:

Shawna from Drumheller asks: My Father has been diagnosed with Crest Syndrome.  I have gone to my family physician because of this family history and have found through some basic testing that I am ANA+. They have tested for lupus but nothing come back. Is this something that I should have further investigated or should I not be concerned?

For everyone else, CREST syndrome is now more commonly referred to limited scleroderma, or systemic sclerosis.  CREST stands for Calcinosis, Raynaud’s, Esophageal Dysmotility, Sclerodactyly and Telangiectasias, which are common but not complete manifestations of scleroderma.

An ANA test is a non-specific test on its own.  Approximately 10% of the population is ANA+, and over 95% of them will never have an autoimmune disease.  The most important thing to do, whether or not an individual is ANA positive, is to always monitor for manifestations of illness and to follow up with your physician at that time.  For more on lupus, click here.

Q:

Anna from Port Alberni, BC asks: I really have no symptoms, but my doctor is concerned that I have mixed connective tissue disease because my RNP test is positive.  What should I do?

Mixed connective tissue disease (MCTD) is similar and has some overlap to systemic lupus.  By definition, an antibody test called RNP should be positive in MCTD.  However, as in many conditions and tests in rheumatology, a positive test does not necessarily diagnose a disease.  Conversely, a negative test does not always rule out a disease either.  To truly make a diagnosis of MCTD, lupus, rheumatoid arthritis, or many other rheumatic diseases, your doctor/rheumatologist needs to review your personal history with you, complete a physical examination, review the appropriate tests and put all that information together to make an informed diagnosis.

Q:

Jack from Edmonton asks: I have been told I have skin lupus, but is there such a problem?

While our website focusses on systemic lupus, there are other forms of lupus, particularly those that affect only the skin.  Dermatologists usually treat these forms of lupus, not rheumatologists, with topical medications or medications like chloroquine or hydroxychloroquine.  It is not uncommon that a rheumatologist will see a patient with “skin only lupus” to make sure they do not have any other manifestations that suggest the skin is in fact only one component of systemic lupus.

Q:

Molly from Portland asks: In regards to Lupus, I was interested in learning about the connection between how high an ANA titer was and disease activity and/or severity. Is there any way someone with a low titre could have more activity and/or more severe signs and symptoms than someone with a higher titre?

In 2013, most patients who have systemic lupus must be ANA positive. Conversely, a negative ANA essentially rules out a diagnosis of systemic lupus. However, an ANA test is not typically used to follow disease activity. Therefore, a higher titre does not correlate well with disease activity. Other investigations, including markers of inflammation, complement levels, and other antibodies correlate better, but even then, it is not a perfect tool.

Q:

Michelle from Sunny Island Beach asks: I have RA and Lupus and have been taking Methotrexate and Plaquenil in combination with rituximab. My insurance will no longer cover Rituxan but it will cover Humira or Enbrel. Is it possible to replace rituximab with a TNF blocker? My doctor told me I can’t “step down” from rituximab to another medication.

For rheumatoid arthritis, there is no clear evidence to suggest any biologic when used under optimal conditions is better than another. A patient would never be stepping down between different biologics, just switching. However, patients with lupus do need to be cautious with TNF blockers as they can exacerbate their disease. Rituximab is considered safer for lupus patients.



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