kathi I copied and pasted the better article. the web address is here too

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On Call Online rheumatology questions

More recent rheumatology questionsThese answers are not meant to replace the personal care or advice of your physician. Please consult with your physician regarding your medical care. Your browser may allow you to search this web page for a keyword or phrase by using the find command.

FINDADOC

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Ear pain and autoimmune diseases

For several years I have been experiencing, during sleep, excruciating pain in my right upper external ear. The pain is only relieved after I raise my head from the pillow for several minutes. Additionally, there seems to be a break in the cartilage. I experienced similar pain about 10 years ago except the affected area was my entire rib region. I continue to have a ghost of the rib pain and numbness in the middle of my chest, including the inner portion of both breasts.

I have been examined by several doctors and given diagnoses of MS (without diagnostic tests), recurrent polychondritis and arthritis. One doctor even said, "don't worry about it." The difference in these diagnoses has me baffled. Pain so excruciating must come from somewhere.

What diseases or disorders could cause these symptoms, and what kind of doctor should I consult?   From the information you provided, relapsing polychondritis sounds like a possibility. It is defined as an episodic, inflammatory and destructive disorder involving cartilage and other connective tissues including the ear, joints, nose, larynx, trachea, eye, heart valves and blood vessels. This disease is similar to other autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis, meaning the immune system makes antibodies against itself. Often, it is difficult to make a diagnosis in the early stages of these diseases and lab tests may be inconclusive or unavailable. Sometimes physicians take a wait-and-see approach, which can be frustrating. Diagnosis is made on clinical symptoms over time.

It may be helpful to see a rheumatologist. Tell him or her about your ear pain, which may be connected to your other symptoms. Treatment for polychondritis includes anti-inflammatory drugs, sometimes prednisone and other immunosuppressive agents. FINDADOC

Call to make an appointment with a University of Missouri Health Care physician.

Autoimmune diseases

I have myasthenia gravis and another autoimmune disease not yet diagnosed. With this other disease I run fevers, my heart enlarges, I have plural pain and sporadic ear and breast pain. It hurts more to lie on the left side and it's hard to breathe if I lean back. I have a dull ache under the sternum.

I just spent seven days in the hospital. My temperature had been cycling between 99 to 102 degrees for six weeks. I always felt sick and could tolerate no activity even on days when my temperature was only 99. I took a course of antibiotics without result. When I was admitted, my doctor put me on IV antibiotics for two days without result. My ESR (erythrocyte sedimentation rate) on admission was 120, my white blood cell count was 17,000. I had respiratory problems, but I believe that was due to the myasthenia. All blood cultures were normal. I have had a history of pericarditis and pleurisy and optic neuritis. These fevers started in August of '98. I have low-grade fevers to 100.5, but they normally resolve themselves. I also have rosacea and endometriosis. My antinuclear antibodies test was negative with this last set of fevers, although I have had mild positive results in the past. Though I had cardiomegaly no tests were done to check this out. In fact, I didn't discover it myself until I read it myself on the X-ray report. My heart was normal size in December '97 and small to normal in February '97. My heart enlarges with these fevers. I responded immediately to steroids. What other autoimmune diseases affect the heart besides lupus?   Other autoimmune diseases that can have heart-related symptoms are Scleroderma, a chronic disease characterized by degenerative changes and scarring in the skin, joints, and internal organs and by blood vessel abnormalities. Pericarditis, which can occur in Sjogren's syndrome. Relapsing polychondritis, a disorder characterized by episodes of painful, destructive inflammation of the cartilage and other connective tissues including heart valves. Wegener's granulomatosis, an uncommon disease that often begins with an inflammation of the lining of the nose, sinuses, throat, or lungs and may progress to an inflammation of blood vessels throughout the body, possibly causing a heart attack as the end result of diseased arteries to the heart. Ankylosing spondylitis, a connective-tissue disease that can injure heart valves and other areas of the body.FINDADOC

Call to make an appointment with a University of Missouri Health Care physician.

Pyoderma gangrenosum

I have had rheumatoid arthritis for 10 years. Three years ago I developed pyoderma gangrenosum, which is an autoimmune disease associated with my arthritis. I have two open wounds on my legs. Each is about the size of a baseball. The wound on the left leg is one of the original ones I developed three years ago. The one on my right leg started with a tiny nick from my razor and became a big, painful, ugly wound.

I have tried many, many drugs including pulse steroid treatment and Cytoxan Now I am taking Prograf along with prednisone. But these wounds aren't getting much better. Also, I've been on Prograf since June and my kidneys are starting to be affected. Tomorrow my doctor will tell me whether I should stop taking it.

The next plan of attack is thalidomide. Have you had any experience using thalidomide on patients with my condition? I am 50 years old.   Some studies are using thalidomide for a variety of conditions including vasculitis in HIV and a syndrome called Behcet's. Other than AIDS trials, we have not been able to obtain this drug in the United States yet. From the description, it has the potential to be used for your condition. FINDADOC

Call to make an appointment with a University of Missouri Health Care physician.

Lupus and platelets

A friend who has lupus has been bleeding vaginally, on and off, for about six months. She has been in the hospital four times. Her platelet count has been very low (14,000). The doctors took her off Plaquenil and Cytoxan. What can she do to rebuild her platelets?   Lupus is a chronic, autoimmune disease, which means the body's immune system makes antibodies against itself. Lupus can affect various parts of the body, including the skin, joints, blood, and kidneys. Some people with systemic lupus have low platelet counts because of the disease process itself, however medications also can contribute to platelet count being low. This probably is why her physicians stopped the Plaquenil and Cytoxan. Platelets are essential for blood to clot, so your friend's low platelet count probably is a factor in her continuing problem with vaginal bleeding. A normal platelet count is anywhere between 150,000 to 400,000. Usually, a transfusion of platelets and time off the medication will help raise them again. FINDADOC

Call to make an appointment with a University of Missouri Health Care physician.

Lupus and pregnancy

I am 20 years old and three months pregnant. I am under the care of an obstetrician and a rheumatologist. I was diagnosed with idiopathic thrombocytopenic purpura (ITP) in '93 after having my first child. During my first pregnancy I did not have any symptoms but I did have complications during labor. My platelets dropped to 50,000 while I was in labor. I went to see a hematologist who referred me to a rheumatologist. I was having symptoms of joint pain, swelling, bruising, bleeding for no reason, fatigue, stress, etc. My ANA test came back positive but the rheumatologist said she could not give me a diagnosis of lupus. Now that I'm pregnant for the second time, I'm afraid I will go through the same troubles I had with my first pregnancy.

From the reading I've done about lupus, I think I've got it. I've always suffered with back and joint pain, swelling, sudden nosebleeds, tiredness and, recently, bleeding from the rectum. Since my first pregnancy, I've had symptoms of bruising, sores in my mouth and sudden skin redness that goes away after awhile. How long does it take for lupus to be diagnosed? I have never been able to get a doctor to tell me why I have nosebleeds, joint and back pain, stiffness in the morning and other symptoms. All I hear is take care of yourself and come back next month for more blood work. I got to the point were I stopped seeing the doctor, but now that I'm pregnant again I've started seeing a new rheumatologist. I am scared for myself and my children.   Lupus is diagnosed on the basis of its symptoms, particularly if they occur in young women. Because of the wide range of symptoms, distinguishing lupus from similar diseases can be difficult. A blood test can detect antinuclear antibodies, which are present in almost all people who have lupus. However, these can also appear in other diseases. Therefore, a test for antibodies to double-stranded DNA is performed. A high level of these antibodies is almost specific for lupus, but not all people who have lupus have these antibodies. The course of lupus is unpredictable, therefore the prognosis varies widely. The disease tends to be chronic and relapsing, often with symptom-free periods that can last for years. Flare-ups rarely occur after menopause. Pregnancy can aggravate the symptoms of lupus. Be sure your rheumatologist and obstetrician are communicating. An obstetrician who is experienced in high-risk pregnancies and lupus should be caring for you, even if a diagnosis has not been confirmed. He or she would be on top of any problems, should they develop. More rheumatology questions

muhealth.org/~oncall/rheumatology01v.shtml  What's happening at MU Health Care? Check the calendar.

Copyright © University of Missouri-Columbia, DMCA and other copyright information   Disability resources, Statement of nondiscrimination  

[Guest guest]

http://www.hsc.missouri.edu/~oncall/rheumatology01v.shtml

 University of Missouri Health Care

E-mail | E-services | Menus | Practice opportunities  About  MU Health Care

 E-mail patients

 Find a doctor

 Hospitals, clinics

 Research

 Schools

 Search MU Health

One Hospital Drive

Columbia, MO 65212

We no longer answer new questions

On Call search

Questions by condition Related sources

On Call Online rheumatology questions

More recent rheumatology questionsThese answers are not meant to replace the personal care or advice of your physician. Please consult with your physician regarding your medical care. Your browser may allow you to search this web page for a keyword or phrase by using the find command.

FINDADOC

Call to make an appointment with a University of Missouri Health Care physician.

Ear pain and autoimmune diseases

For several years I have been experiencing, during sleep, excruciating pain in my right upper external ear. The pain is only relieved after I raise my head from the pillow for several minutes. Additionally, there seems to be a break in the cartilage. I experienced similar pain about 10 years ago except the affected area was my entire rib region. I continue to have a ghost of the rib pain and numbness in the middle of my chest, including the inner portion of both breasts.

I have been examined by several doctors and given diagnoses of MS (without diagnostic tests), recurrent polychondritis and arthritis. One doctor even said, "don't worry about it." The difference in these diagnoses has me baffled. Pain so excruciating must come from somewhere.

What diseases or disorders could cause these symptoms, and what kind of doctor should I consult?   From the information you provided, relapsing polychondritis sounds like a possibility. It is defined as an episodic, inflammatory and destructive disorder involving cartilage and other connective tissues including the ear, joints, nose, larynx, trachea, eye, heart valves and blood vessels. This disease is similar to other autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis, meaning the immune system makes antibodies against itself. Often, it is difficult to make a diagnosis in the early stages of these diseases and lab tests may be inconclusive or unavailable. Sometimes physicians take a wait-and-see approach, which can be frustrating. Diagnosis is made on clinical symptoms over time.

It may be helpful to see a rheumatologist. Tell him or her about your ear pain, which may be connected to your other symptoms. Treatment for polychondritis includes anti-inflammatory drugs, sometimes prednisone and other immunosuppressive agents. FINDADOC

Call to make an appointment with a University of Missouri Health Care physician.

Autoimmune diseases

I have myasthenia gravis and another autoimmune disease not yet diagnosed. With this other disease I run fevers, my heart enlarges, I have plural pain and sporadic ear and breast pain. It hurts more to lie on the left side and it's hard to breathe if I lean back. I have a dull ache under the sternum.

I just spent seven days in the hospital. My temperature had been cycling between 99 to 102 degrees for six weeks. I always felt sick and could tolerate no activity even on days when my temperature was only 99. I took a course of antibiotics without result. When I was admitted, my doctor put me on IV antibiotics for two days without result. My ESR (erythrocyte sedimentation rate) on admission was 120, my white blood cell count was 17,000. I had respiratory problems, but I believe that was due to the myasthenia. All blood cultures were normal. I have had a history of pericarditis and pleurisy and optic neuritis. These fevers started in August of '98. I have low-grade fevers to 100.5, but they normally resolve themselves. I also have rosacea and endometriosis. My antinuclear antibodies test was negative with this last set of fevers, although I have had mild positive results in the past. Though I had cardiomegaly no tests were done to check this out. In fact, I didn't discover it myself until I read it myself on the X-ray report. My heart was normal size in December '97 and small to normal in February '97. My heart enlarges with these fevers. I responded immediately to steroids. What other autoimmune diseases affect the heart besides lupus?   Other autoimmune diseases that can have heart-related symptoms are Scleroderma, a chronic disease characterized by degenerative changes and scarring in the skin, joints, and internal organs and by blood vessel abnormalities. Pericarditis, which can occur in Sjogren's syndrome. Relapsing polychondritis, a disorder characterized by episodes of painful, destructive inflammation of the cartilage and other connective tissues including heart valves. Wegener's granulomatosis, an uncommon disease that often begins with an inflammation of the lining of the nose, sinuses, throat, or lungs and may progress to an inflammation of blood vessels throughout the body, possibly causing a heart attack as the end result of diseased arteries to the heart. Ankylosing spondylitis, a connective-tissue disease that can injure heart valves and other areas of the body.FINDADOC

Call to make an appointment with a University of Missouri Health Care physician.

Pyoderma gangrenosum

I have had rheumatoid arthritis for 10 years. Three years ago I developed pyoderma gangrenosum, which is an autoimmune disease associated with my arthritis. I have two open wounds on my legs. Each is about the size of a baseball. The wound on the left leg is one of the original ones I developed three years ago. The one on my right leg started with a tiny nick from my razor and became a big, painful, ugly wound.

I have tried many, many drugs including pulse steroid treatment and Cytoxan Now I am taking Prograf along with prednisone. But these wounds aren't getting much better. Also, I've been on Prograf since June and my kidneys are starting to be affected. Tomorrow my doctor will tell me whether I should stop taking it.

The next plan of attack is thalidomide. Have you had any experience using thalidomide on patients with my condition? I am 50 years old.   Some studies are using thalidomide for a variety of conditions including vasculitis in HIV and a syndrome called Behcet's. Other than AIDS trials, we have not been able to obtain this drug in the United States yet. From the description, it has the potential to be used for your condition. FINDADOC

Call to make an appointment with a University of Missouri Health Care physician.

Lupus and platelets

A friend who has lupus has been bleeding vaginally, on and off, for about six months. She has been in the hospital four times. Her platelet count has been very low (14,000). The doctors took her off Plaquenil and Cytoxan. What can she do to rebuild her platelets?   Lupus is a chronic, autoimmune disease, which means the body's immune system makes antibodies against itself. Lupus can affect various parts of the body, including the skin, joints, blood, and kidneys. Some people with systemic lupus have low platelet counts because of the disease process itself, however medications also can contribute to platelet count being low. This probably is why her physicians stopped the Plaquenil and Cytoxan. Platelets are essential for blood to clot, so your friend's low platelet count probably is a factor in her continuing problem with vaginal bleeding. A normal platelet count is anywhere between 150,000 to 400,000. Usually, a transfusion of platelets and time off the medication will help raise them again. FINDADOC

Call to make an appointment with a University of Missouri Health Care physician.

Lupus and pregnancy

I am 20 years old and three months pregnant. I am under the care of an obstetrician and a rheumatologist. I was diagnosed with idiopathic thrombocytopenic purpura (ITP) in '93 after having my first child. During my first pregnancy I did not have any symptoms but I did have complications during labor. My platelets dropped to 50,000 while I was in labor. I went to see a hematologist who referred me to a rheumatologist. I was having symptoms of joint pain, swelling, bruising, bleeding for no reason, fatigue, stress, etc. My ANA test came back positive but the rheumatologist said she could not give me a diagnosis of lupus. Now that I'm pregnant for the second time, I'm afraid I will go through the same troubles I had with my first pregnancy.

From the reading I've done about lupus, I think I've got it. I've always suffered with back and joint pain, swelling, sudden nosebleeds, tiredness and, recently, bleeding from the rectum. Since my first pregnancy, I've had symptoms of bruising, sores in my mouth and sudden skin redness that goes away after awhile. How long does it take for lupus to be diagnosed? I have never been able to get a doctor to tell me why I have nosebleeds, joint and back pain, stiffness in the morning and other symptoms. All I hear is take care of yourself and come back next month for more blood work. I got to the point were I stopped seeing the doctor, but now that I'm pregnant again I've started seeing a new rheumatologist. I am scared for myself and my children.   Lupus is diagnosed on the basis of its symptoms, particularly if they occur in young women. Because of the wide range of symptoms, distinguishing lupus from similar diseases can be difficult. A blood test can detect antinuclear antibodies, which are present in almost all people who have lupus. However, these can also appear in other diseases. Therefore, a test for antibodies to double-stranded DNA is performed. A high level of these antibodies is almost specific for lupus, but not all people who have lupus have these antibodies. The course of lupus is unpredictable, therefore the prognosis varies widely. The disease tends to be chronic and relapsing, often with symptom-free periods that can last for years. Flare-ups rarely occur after menopause. Pregnancy can aggravate the symptoms of lupus. Be sure your rheumatologist and obstetrician are communicating. An obstetrician who is experienced in high-risk pregnancies and lupus should be caring for you, even if a diagnosis has not been confirmed. He or she would be on top of any problems, should they develop. More rheumatology questions

muhealth.org/~oncall/rheumatology01v.shtml  What's happening at MU Health Care? Check the calendar.

Copyright © University of Missouri-Columbia, DMCA and other copyright information   Disability resources, Statement of nondiscrimination