Another Diagnosis

[Guest guest]

,

As much as I would like to believe the diognosis of Lupus might be a

misdiagnosis, there are several facts that stand. The ANA's although low had

started showing positive before I began Enbrel, so I started injectables knowing

that we were suspicious and that I would be immediately taken off the injections

if my very conservative Rheumy determined it was Lupus. (Not only was my Rheumy

suspicious of Lupus but also my Internist.) Add to that the disease history,

family history, continued ANA's, and positives on a group of tests including

Anti-DNA, Anti-RNP/SM/SSA/SSB, etc pretty much proved itself (I expect the

positives on the DNA and SM was the clincher.) I know that this Rheumatologist

would not give me a " positive diagnosis of Lupus " were he not certain. In fact,

a less conservative doctor may have jumped to this conclusion much sooner and

perhaps without allowing the proper criterion to play itself out and then the

lab tests to back up the decision. We have been working toward ruling this

diagnosis in or out for over a year....and one would think that you would be

prepared for such a diagnosis given that much time, but I will share that this

is the one diagnosis that really has rocked me.

Additionally, some months back when I too believing that it was " rare " for one

to have both RA and Lupus asked about it, I was told that although " unusual " it

is not rare but does make the treatment more complex. And to make my treatment

even more complex, one of the drugs of choice for Lupus I have already proven to

have a true allergy to and a second one some nasty side effects......so much for

making treatment simple!!

Thank you for your suggestions and concern, without knowing my history they were

very valid.

Janie in OK

Janie, there are a couple of important facts you should know before you

conclude that you have lupus in addition to your RA.

1) In the absence of an overlap syndrome, the occurrence of RA and lupus

in a single individual is rare.

2) ANA positivity is common in RA patients - easily 30% of RA patients

are ANA positive. A diagnosis of lupus cannot be based on ANA positivity

alone. Many non-lupus conditions and diseases are associated with ANA

positivity.

3) Certain drugs, most notably in your case the TNF blockers (you were

on Enbrel and you are now on Humira), cause what is known as

" drug-induced lupus. " This is when labs and sometimes clinical signs and

symptoms of lupus appear because of a certain medication. Most often,

the

labs return to normal and the symptoms disappear after the offending

drug is discontinued. Serious clinical developments (like lupus kidney

disease) are rare in drug-induced lupus. As you see from the article

below, although many people on anti-TNF therapies develop antibodies

associated with lupus, few develop clinical lupus.

" Anti-TNF therapy represents a significant advance in the treatment of

rheumatoid arthritis. It has also become apparent that patients

receiving either anti-TNF monoclonal antibodies or TNF receptor

antagonists can develop serological evidence of autoimmunity (11). In

one study, new ANA and anti-dsDNA antibodies were found in 33% and 9% of

infliximab recipients, respectively. However, there is clear

discordance between the development of autoantibodies and clinical

autoimmunity, with less than 20 symptomatic patients reported in the

literature and in abstract form. "

Bulletin on the Rheumatic Diseases

Volume 51 Number 4

Drug-induced Lupus (DIL)

http://www.arthritis.org/research/bulletin/vol51no4/51_4_Drug-induced.asp

Besides a positive ANA, what is leading your physician to say that you

have lupus, too?