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Have deficient IgG1 and IgG3. Diagnosed CVID. Suffer severe joint and chest pain. Predinisone lower immunoglobulan to deficiency?

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Pulmonologist
Practicing since : 2003
Answered : 598 Questions
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Hi Doc,

Where to start?

I have been very unwell for about 7 years now - but recently they have noticed that I am deficient in IgG1 and IgG3 and it looks like I might finally have a diagnosis as CVID they suspect that my Low O2 sats were from Bronchiastasis from recurrent chest infections and this has also made me borderline hypoxic, they also suspect that the massive joint and chest pains (almost always with synovial involvement) have been having are from Autoimmune diseases - caused by Immune dysfunction due to Immunological deficiency - I definitely have classic Psoriatic Arthritis and possible Lupos as well as Gout.

My concern is that no one could work this out for years, it is only by chance that my Respiratory Physician looked back through my previous blood tests and found the low IgG1 and IgG3 results, he since did an antibody test to Diptheria / Tetenas which which showed that my immune system is not responding properly (still awaiting pnuemoccocil test as well) - that said I have not even seen an Immunologist (very hard to get into see one as they are sooo busy) but my respiratory doctor has told me to start on Intragram IVIG replacement therapy.

I think he is on the right track, however I want to be sure that other things could not have lowered my IgG results - ie with my massive joint issues, I am often on high dose prednisone 50mg and I have been on Sulphasalazine as well at the time of testing IgG - so could these have lowered IG levels?

So my Questions are;

Does Predinisone or Sulphasalazine lower immunoglobulan to the point of deficiency?

I will need some treatment for my rhuematalogical disorders - but obviously I need to lower Immune response in order to help with this issue - but lowering immune response will affect my ability to fight off infections - so how do you achieve both goals - and if I have to do both - what drug lowers Immune response less - ie what drug could I take for Psoriatic Arthritus that would be least damaging to my already low Immunoglobulan?

I have tried Methotrexate and Sulphasalazine with limited result, but what about Humira - which will be best for me?

Did my autoimmune rheumatoid issues cause the lower IgG levels ( I don't flare up, I am constantly attacked with everyday joint involvement so perhaps my immune system is burnt out?) or did the lower IG levels make me acquire rheumatoid diseases?

8/ What are the chances of our children developing the disease issues I have - we have not had any yet but considering it?

Do Rhuematological issues sometimes get better after IVIG therapy?

Could my joint pains be from Bacteria - due to low IgG

Are there any food allergies that can lower IG - I seem to react to certain foods like seafood etc?
Posted Wed, 16 Oct 2013 in Asthma and Allergy
 
 
Answered by Dr. Gyanshankar Mishra 7 days later
Brief Answer:
A more detailed evaluation is required.

Detailed Answer:
Hi,
Thanks for posting the query on XXXXXXX After going through your query, I would like to comment the following:

1. Does Predinisone or Sulphasalazine lower immunoglobulan to the point of deficiency?

Ans: You have selective IgG1 and IgG3 deficiency. Actually immunosupressive therapy can cause IgG deficiencies but they are more known with the class IgG2 and IgG4.

2. I will need some treatment for my rhuematalogical disorders - but obviously I need to lower Immune response in order to help with this issue - but lowering immune response will affect my ability to fight off infections - so how do you achieve both goals - and if I have to do both - what drug lowers Immune response less - ie what drug could I take for Psoriatic Arthritus that would be least damaging to my already low Immunoglobulan?

Ans: Psoriasis is a disease associated with abnormal immune response/ autoimmunity and hence immunosprresive management is required with the disease. Takning an immunosuppresive therapy and hoping that the immunosuppression will be mild is not practical. Rather you can take vaccines eg. Pneumococcal and flu to prevent infections in future, even though there efficacies will be decreased and also you need to visist your doctor early if any symptoms of infections develop.

3. I have tried Methotrexate and Sulphasalazine with limited result, but what about Humira - which will be best for me?

Ans: Humira or Adalimumab is TNF blocker and is an option when there is'nt adequate response to standard DMARD's.As per guidelines "This agent is reserved for those who experience an inadequate response to 1 or more DMARDs". In psoriatic Arthritis . Adalimumab has been shown to superior to Methotrexate (ADEPT Trial).

4. Did my autoimmune rheumatoid issues cause the lower IgG levels ( I don't flare up, I am constantly attacked with everyday joint involvement so perhaps my immune system is burnt out?) or did the lower IG levels make me acquire rheumatoid diseases?
Ans: Infact studies have shown raised IgG levels in Rheumatoid Arthritis!

5/ What are the chances of our children developing the disease issues I have - we have not had any yet but considering it?

Ans: Rheumatoid arthritis does have a familial predisposition.

6. Do Rhuematological issues sometimes get better after IVIG therapy?
Ans: IVIG therapy may be indicated in you considering your low IgG level. Currently it is not the standard treatment in rheumatoid or psoriatic arthritis hence predicting its response for joint pains is not possible.

7. Could my joint pains be from Bacteria - due to low IgG
Ans: A bacterial arthritis is normally localised and shows signs of local inflammation. A joint fluid aspiration is indicated in such cases and response to antibiotics is expected. Since you haven't mentioned features of localised infection and inflammation, it seems unlikely. However low IgG levels does place you at increased risk of infections.

8. Are there any food allergies that can lower IG - I seem to react to certain foods like seafood etc?
Ans: Its more commonly, IgE rhat is related with allergies. Actually it is the high IgG levels that may sometimes associated with specific allergies eg. food.

Additional acooment: It is recommended that an extranuclear antigen profile testing be done to exclude other collagen vascular causes. RA is known to affect the lungs seperately. Has a HRCT scan thorax ever been done? What were it's findings?

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
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