Re: Just joined the group -

[Guest guest]

Hi :

I went back on the net to try to find the article that I was referring to in

my first post, but of course I couldn't. However, I did find this info

below. It is all so confusing, but just wanted to share with you what I

found.

**

*The Presence of Other Autoimmune Disorders*

*Rheumatoid Arthritis.* Studies have investigated the relationship among

hormones, SLE, and rheumatoid arthritis, another autoimmune disease. Higher

levels of estrogen are associated with SLE, while *lower* levels are

associated with rheumatoid arthritis. Some research suggests that some

patients, in fact, progress from one disease to the other, and that such

transitions occur during major hormonal shifts, such as the onset of

menopause or pregnancy.

On Lupus.org I found this:

*Lupus and Rheumatoid Arthritis*

In lupus, joint pain (arthralgia) is common. Joint swelling (arthritis) may

be present in some cases, but the majority of those with lupus experience

joint pain without swelling or only intermittent swelling. In rheumatoid

arthritis (RA), joint swelling is always present and pain is common but less

prominent. Because rheumatoid arthritis is more likely than lupus to cause

joint deformities and bone destruction, joint replacement or reconstructive

surgery is more often required in RA than in SLE. If a person with lupus

develops severe arthritis with joint deformities, he/she should be

considered to have rheumatoid-like arthritis. In some instances, the

physician might have reason to believe that both diseases -- SLE and RA --

have occurred in the same person. When arthritis develops in the course of

lupus, treatment with non-steroidal anti-inflammatory drugs (NSAIDs), low

doses of cortisone, and the antimalarial drug hydroxychloroquine (Plaquenil)

are usually helpful. People with lupus who have typical rheumatoid arthritis

are prescribed the standard forms of RA treatment. These include

methotrexate, sulfasalazine and in some cases, more potent drugs to suppress

joint inflammation.

On Fri, May 8, 2009 at 6:11 PM, <

Rheumatoid.Arthritis.Support@...> wrote:

> Welcome to the group, Susie. I'm sorry about all of your health problems.

>

> I'm not sure where you read that information about lupus, but it isn't

> true. People with RA don't have to worry about developing lupus. It's

> actually very uncommon to have both diseases.

>

> It is possible to go from seronegative RA to seropositive RA.

>

>

>

> Not an MD

>

>

>

> On Fri, May 8, 2009 at 5:41 PM, susbartholow <susbartholow@...>

> wrote:

> >

> >

> > Hello everyone. My name is Susie Bartholow and I was diagnosed with RA

> last

> > week. I live in the Ft. Worth, Texas area with my husband and 2 little

> > Chihuahuas. I have lots of questions and probably more as time goes by. I

> > also have Fibromyalgia, severe osteoporosis, DDD, DJD, IBS and now RA.

> >

> > Here is my first question. My rheumatologist performed tons of blood

> tests

> > before diagnosing me. He told me that all of my signs and symptoms and

> MRIs,

> > CTs and x-rays showed me to have RA, but that my blood work showed

> negative

> > for RA. So he said what I actually have is " sero-negative " RA. So I have

> > done some research on this and what I read said that this was the kind of

> RA

> > to have, if you have it. However, I also read that when a person has

> > sero-positive RA that they need to be very concerned about the

> possibility

> > of having Lupus.

> >

> > This is all new to me, the RA thing. So could someone please explain to

> me

> > if the symptoms are different with sero-negative RA, can it turn into

> > sero-positive RA and what about the Lupus thing. What do I need to watch

> > for.

> >

> > I am really looking forward to learning more about RA and meeting people

> > that have it.

> >

> > Thanks,

>

>

> ------------------------------------

>

>

[Guest guest]

Susie,

Sometimes, especially early in the disease process, it's difficult to

determine whether it's RA or lupus. It's not uncommon to be

misdiagnosed. It's also not unusual for certain individuals to have a

few symptoms of both RA and SLE (but not both diseases).

If you have the clinical features of RA and supporting imaging reveals

changes consistent with RA, the chance that you will also have lupus

in the future or that your diagnosis will change to lupus is very

small. Did your rheumatologist also test you for anti-CCP antibodies?

The abstract of the study from 1999 which is referred to in the first

part of your post (I'm not sure of your source - maybe Adam.com?) is

below. The summary you read is fairly misleading. In the study, the

authors discuss 7 SLE cases which later became RA (7 cases/ 893 lupus

patients = 0.0078 = 0.78% of the study population of lupus patients

whose diagnosis was changed to RA), not the other way around. I think

it could also be argued that those seven may have been misdiagnosed in

the first place, but I don't have access to the full study. It was a

retrospective study, so misdiagnosis could be an issue.

********************************************

J Clin Rheumatol. 1999 Feb;5(1):9-16.

Influence of hormonal events on disease expression in patients with

the combination of systemic lupus erythematosus and rheumatoid

arthritis.

Sundaramurthy SG, Karsevar MP, van Vollenhoven RF.

Division of Immunology & Rheumatology, Stanford University Medical

Center, Stanford, California.

The concurrent presence of systemic lupus erythematosus (SLE) and

rheumatoid arthritis (RA) ( " rhupus " or " rufus " ) has been described in

the literature. However, it has not been clear to what extent and

under what circumstances clinical disease expresssion can undergo

transitions from one disease to the other. We postulated that major

hormonal events might have an influence on disease expression in such

patients and conducted a retrospective study of 1507 patients with RA

and 893 with SLE. In this population, 13 patients were identified as

having convincing clinical diagnoses of both RA and SLE. Although 6 of

these 13 patients had symptoms and signs of RA and SLE concurrently

during their entire illness, 7 patients had clearly identifiable

transitions from SLE to RA, and in one of these patients the reverse

occurred as well. Of the 7 transitions from SLE to RA, 5 were

associated with menopause (3 of these patients were receiving hormone

replacement therapy) and the other 2 occurred in the postpartum

period. The one change from RA to SLE in this series occurred during

pregnancy. Thus, pregnancy, the postpartum period, and menopause can

modulate disease expression in patients with both SLE and RA. It is

speculated that, in patients with an autoimmune predilection, a

high-estrogen environment (premenopause, pregnancy) favors the

clinical expression of SLE, whereas a low-estrogen environment favors

more RA-like disease, possibly because of the immunomodulatory effects

of sex-steroids. The clinical implication is that in the management of

patients with autoimmune diseases such as SLE and RA, hormonal

alterations could result in changes in disease expression that might

necessitate changes in treatment.

PMID: 19078342

http://www.ncbi.nlm.nih.gov/pubmed/19078342

******************************************

Not an MD

On Fri, May 8, 2009 at 10:52 PM, Susie Bartholow <susbartholow@...> wrote:

>

>

> Hi :

>

> I went back on the net to try to find the article that I was referring to in

> my first post, but of course I couldn't. However, I did find this info

> below. It is all so confusing, but just wanted to share with you what I

> found.

>

> **

>

> *The Presence of Other Autoimmune Disorders*

>

> *Rheumatoid Arthritis.* Studies have investigated the relationship among

> hormones, SLE, and rheumatoid arthritis, another autoimmune disease. Higher

> levels of estrogen are associated with SLE, while *lower* levels are

> associated with rheumatoid arthritis. Some research suggests that some

> patients, in fact, progress from one disease to the other, and that such

> transitions occur during major hormonal shifts, such as the onset of

> menopause or pregnancy.

>

> On Lupus.org I found this:

>

> *Lupus and Rheumatoid Arthritis*

>

> In lupus, joint pain (arthralgia) is common. Joint swelling (arthritis) may

> be present in some cases, but the majority of those with lupus experience

> joint pain without swelling or only intermittent swelling. In rheumatoid

> arthritis (RA), joint swelling is always present and pain is common but less

> prominent. Because rheumatoid arthritis is more likely than lupus to cause

> joint deformities and bone destruction, joint replacement or reconstructive

> surgery is more often required in RA than in SLE. If a person with lupus

> develops severe arthritis with joint deformities, he/she should be

> considered to have rheumatoid-like arthritis. In some instances, the

> physician might have reason to believe that both diseases -- SLE and RA --

> have occurred in the same person. When arthritis develops in the course of

> lupus, treatment with non-steroidal anti-inflammatory drugs (NSAIDs), low

> doses of cortisone, and the antimalarial drug hydroxychloroquine (Plaquenil)

> are usually helpful. People with lupus who have typical rheumatoid arthritis

> are prescribed the standard forms of RA treatment. These include

> methotrexate, sulfasalazine and in some cases, more potent drugs to suppress

> joint inflammation.

[Guest guest]

Susie,

I forgot the percentage for the one patient who went from RA to SLE:

1/1507 = 0.066%. That is a very small percentage even if the diagnosis

is correct.

Not an MD

On Sat, May 9, 2009 at 12:38 PM,

<rheumatoid.arthritis.support@...> wrote:

> Susie,

>

> Sometimes, especially early in the disease process, it's difficult to

> determine whether it's RA or lupus. It's not uncommon to be

> misdiagnosed. It's also not unusual for certain individuals to have a

> few symptoms of both RA and SLE (but not both diseases).

>

> If you have the clinical features of RA and supporting imaging reveals

> changes consistent with RA, the chance that you will also have lupus

> in the future or that your diagnosis will change to lupus is very

> small. Did your rheumatologist also test you for anti-CCP antibodies?

>

> The abstract of the study from 1999 which is referred to in the first

> part of your post (I'm not sure of your source - maybe Adam.com?) is

> below. The summary you read is fairly misleading. In the study, the

> authors discuss 7 SLE cases which later became RA (7 cases/ 893 lupus

> patients = 0.0078 = 0.78% of the study population of lupus patients

> whose diagnosis was changed to RA), not the other way around. I think

> it could also be argued that those seven may have been misdiagnosed in

> the first place, but I don't have access to the full study. It was a

> retrospective study, so misdiagnosis could be an issue.

>

>

> ********************************************

>

> J Clin Rheumatol. 1999 Feb;5(1):9-16.

>

>

> Influence of hormonal events on disease expression in patients with

> the combination of systemic lupus erythematosus and rheumatoid

> arthritis.

>

>

> Sundaramurthy SG, Karsevar MP, van Vollenhoven RF.

> Division of Immunology & Rheumatology, Stanford University Medical

> Center, Stanford, California.

>

> The concurrent presence of systemic lupus erythematosus (SLE) and

> rheumatoid arthritis (RA) ( " rhupus " or " rufus " ) has been described in

> the literature. However, it has not been clear to what extent and

> under what circumstances clinical disease expresssion can undergo

> transitions from one disease to the other. We postulated that major

> hormonal events might have an influence on disease expression in such

> patients and conducted a retrospective study of 1507 patients with RA

> and 893 with SLE. In this population, 13 patients were identified as

> having convincing clinical diagnoses of both RA and SLE. Although 6 of

> these 13 patients had symptoms and signs of RA and SLE concurrently

> during their entire illness, 7 patients had clearly identifiable

> transitions from SLE to RA, and in one of these patients the reverse

> occurred as well. Of the 7 transitions from SLE to RA, 5 were

> associated with menopause (3 of these patients were receiving hormone

> replacement therapy) and the other 2 occurred in the postpartum

> period. The one change from RA to SLE in this series occurred during

> pregnancy. Thus, pregnancy, the postpartum period, and menopause can

> modulate disease expression in patients with both SLE and RA. It is

> speculated that, in patients with an autoimmune predilection, a

> high-estrogen environment (premenopause, pregnancy) favors the

> clinical expression of SLE, whereas a low-estrogen environment favors

> more RA-like disease, possibly because of the immunomodulatory effects

> of sex-steroids. The clinical implication is that in the management of

> patients with autoimmune diseases such as SLE and RA, hormonal

> alterations could result in changes in disease expression that might

> necessitate changes in treatment.

>

>

> PMID: 19078342

>

> http://www.ncbi.nlm.nih.gov/pubmed/19078342

>

> ******************************************

>

>

> Not an MD

>

[Guest guest]

:

Thanks for the info. I just keep reading and reading to find out as much as

I can. Any help is appreciated.

On Sat, May 9, 2009 at 3:48 PM, <

Rheumatoid.Arthritis.Support@...> wrote:

> Susie,

>

> I forgot the percentage for the one patient who went from RA to SLE:

> 1/1507 = 0.066%. That is a very small percentage even if the diagnosis

> is correct.

>

>

>

> Not an MD

>

>

>

> On Sat, May 9, 2009 at 12:38 PM,

> <rheumatoid.arthritis.support@...> wrote:

> > Susie,

> >

> > Sometimes, especially early in the disease process, it's difficult to

> > determine whether it's RA or lupus. It's not uncommon to be

> > misdiagnosed. It's also not unusual for certain individuals to have a

> > few symptoms of both RA and SLE (but not both diseases).

> >

> > If you have the clinical features of RA and supporting imaging reveals

> > changes consistent with RA, the chance that you will also have lupus

> > in the future or that your diagnosis will change to lupus is very

> > small. Did your rheumatologist also test you for anti-CCP antibodies?

> >

> > The abstract of the study from 1999 which is referred to in the first

> > part of your post (I'm not sure of your source - maybe Adam.com?) is

> > below. The summary you read is fairly misleading. In the study, the

> > authors discuss 7 SLE cases which later became RA (7 cases/ 893 lupus

> > patients = 0.0078 = 0.78% of the study population of lupus patients

> > whose diagnosis was changed to RA), not the other way around. I think

> > it could also be argued that those seven may have been misdiagnosed in

> > the first place, but I don't have access to the full study. It was a

> > retrospective study, so misdiagnosis could be an issue.

> >

> >

> > ********************************************

> >

> > J Clin Rheumatol. 1999 Feb;5(1):9-16.

> >

> >

> > Influence of hormonal events on disease expression in patients with

> > the combination of systemic lupus erythematosus and rheumatoid

> > arthritis.

> >

> >

> > Sundaramurthy SG, Karsevar MP, van Vollenhoven RF.

> > Division of Immunology & Rheumatology, Stanford University Medical

> > Center, Stanford, California.

> >

> > The concurrent presence of systemic lupus erythematosus (SLE) and

> > rheumatoid arthritis (RA) ( " rhupus " or " rufus " ) has been described in

> > the literature. However, it has not been clear to what extent and

> > under what circumstances clinical disease expresssion can undergo

> > transitions from one disease to the other. We postulated that major

> > hormonal events might have an influence on disease expression in such

> > patients and conducted a retrospective study of 1507 patients with RA

> > and 893 with SLE. In this population, 13 patients were identified as

> > having convincing clinical diagnoses of both RA and SLE. Although 6 of

> > these 13 patients had symptoms and signs of RA and SLE concurrently

> > during their entire illness, 7 patients had clearly identifiable

> > transitions from SLE to RA, and in one of these patients the reverse

> > occurred as well. Of the 7 transitions from SLE to RA, 5 were

> > associated with menopause (3 of these patients were receiving hormone

> > replacement therapy) and the other 2 occurred in the postpartum

> > period. The one change from RA to SLE in this series occurred during

> > pregnancy. Thus, pregnancy, the postpartum period, and menopause can

> > modulate disease expression in patients with both SLE and RA. It is

> > speculated that, in patients with an autoimmune predilection, a

> > high-estrogen environment (premenopause, pregnancy) favors the

> > clinical expression of SLE, whereas a low-estrogen environment favors

> > more RA-like disease, possibly because of the immunomodulatory effects

> > of sex-steroids. The clinical implication is that in the management of

> > patients with autoimmune diseases such as SLE and RA, hormonal

> > alterations could result in changes in disease expression that might

> > necessitate changes in treatment.

> >

> >

> > PMID: 19078342

> >

> > http://www.ncbi.nlm.nih.gov/pubmed/19078342

> >

> > ******************************************

> >

> >

> > Not an MD

> >

>

>

> ------------------------------------

>

>