Dr. Kusumakar Srivastava
Diabetology
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Patient's Query
Hello doctor,
I am a 43-year-old female. About a year and a half ago I noticed Raynaud's in one finger. I had three episodes in two years. I have lost most of my eyebrows. Recently, I got three episodes of Raynaud's in both hands and most fingers. I have joint pain that comes and goes in all joints. I have widespread muscle pain that comes and goes. The intensity changes. I am fatigued and just noticed that upon awakening, my fingers are a little swollen. I cannot get my ring off until about one or two hours after waking up. I have had plenty of bloodwork ANAs, ENA, Scl 70, centromere, PM Scl, all of the scleroderma and lupus testing along with Sjogren's. ANCA, P ANCA, CPK, ESR, RF, and ds DNA tests. The only test that was abnormal was C3 and C4 decreased and elevated anticardiolipin IgM. My WBC was also low. Since 99 percent of lupus is shown on positive ANA, what could this imply in the absence of a positive ANA?
Hello,
Welcome to icliniq.com.
I have gone through your query and what I can convey is that in most of the cases, clinical picture is that of systemic sclerosis, scleroderma, SLE (systemic lupus erythematosus) but as per the reports elevated anticardiolipin IgM and decreased complements can also be found in ITP (idiopathic thrombocytopenic purpura), rheumatic, psoriatic arthritis, primary Sjogren's syndrome and in cases of SLE who are at increased risk of vascular thrombosis, thrombocytopenia cerebral infarct and recurrent spontaneous abortion.
Thank you.
Patient's Query
Hello doctor,
When you say sclerosis, scleroderma, and SLE do you mean overlap of both systemic sclerosis and SLE or it may turn into one of the two? Is decreased C3 and C4 seen in systemic sclerosis? Increased anticardiolipin IgM? What is the likelihood of SLE with negative ANA? Same question for systemic sclerosis, what is the likelihood of negative ANA as well as negative Scl 70, centromere, polymerase, etc.? What is your opinion about antibiotic therapy?
Hello,
Welcome back to icliniq.com.
Thanks for asking.
1. It will be one of the two most probably SLE.
2. No very rarely as these are the features of SLE.
3. ANA negative lupus exists but is rare in adults and is usually associated with other autoantibodies (anti-RO or anti-DNA).
4. Antibodies against Scl 70 (topoisomerase 1) and centromere are specific for systemic sclerosis and are mutually exclusive.
5. Very little role of antibiotics in systemic sclerosis only if you are having bacterial overgrowth syndrome (abdominal bloating, diarrhea) then, Metronidazole, Tetracycline, Erythromycin can eradicate that. In SLE there is no role.
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Diabetology
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