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Suffer dry throat, eyes, achy joints, red palms and fatigue. Have high IgG showing polyclonal gammapathy. Suggestions?

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Practicing since : 1998
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I had a high IgG -
showing polyclonal gammapathy

November- Had XXXXXXX 1:80 speckled
April- XXXXXXX 1:160 speckled
Dr Proposed it was Lupus maybe - put me on plaquenil

I stayed on the medication
went to get a 2nd opinion...

Last week 2nd opinion..
he did an XXXXXXX by EIA - it was 1.2 negative .. positive is greater than 1.5
I have also tested negative for the following Antibodies
SM,RNP,SSA,SSB,Centromere,Scleroderma Ab, XXXXXXX 1 antibody, Ribosomal, Chromatin,thyrogloblin

my IgG is still high but not as high as before.
my CRP 0.1 same as before
Sed rate was 15 - which is negative back in April it was 29

I don't know which doctor to go with? Do I stay on the Plaquenil or not..... theres so much controversy-

opinions well appreciated

my symptoms are- dry throat, eyes, achy joints, red palms, fatigue, malise, low grade fevers at times.

lately no low grade fevers. and not really much achiness just very slight.
Posted Wed, 17 Jul 2013 in Blood Disorders
Answered by Dr. Sandhya Manorenj 22 hours later

Thank you for writing in.

Your symptoms of dry eyes, dry throat, joint pains ,low grade fever, are consistent with Sjogrens syndrome.

This has to be confirmed by clinical examination.You should consult Rheumatologist.

Sjogrens syndrome is a chronic slowly progressive autoimmune disease characterized by lymphocytic infiltration of exocrine glands resulting in dry mouth and dry eyes

Usually in Sjogrens syndrome autoantibodies will be positive for SSA (anti RO) and SSB (anti la).

Since it is negative for you, test to be repeated in another lab.If still negative then Sarcoidosis to be considered .Blood angiotensin converting enzyme levels will be elevated in sarcoidosis

Labial (lip) biopsy helps to confirm the diagnosis ( sjogrens or sarcoidosis)

Polyclonal gammapathy indicates chronic inflammatory process.

XXXXXXX is positive in wide range of connective and autoimmune disease. Sjogrens being one among them.

Plaquenil contains hydroxychloroquine which is a disease modifying drug (immunomodulator) and is widely used in autoimmune diseases and is helpful for arthralgias

I suggest you to continue medicine till you XXXXXXX Rheumatologist (ASAP).

For dry mouth and throat best replacement is drink plenty of water.

For dry eyes artificial tears to be used to prevent corneal ulceration.

Certain drugs that may increase lacrimal and salivary hypofunction such as diuretics, anti hypertensive (Nadalol one among them) and antidepressants should be avoided .

Hope I answered your query

Above answer was peer-reviewed by
Follow-up: Suffer dry throat, eyes, achy joints, red palms and fatigue. Have high IgG showing polyclonal gammapathy. Suggestions? 2 hours later
Hi there- I will ask the Rheumi about being tested for Sjrojens by lip Biopsy- I have P.O.T.S and I heard that Sjrojens is pretty common among POTS patients (postural orthostatic tachycardia syndrome) . . .

As for sarcoidisis? would that be seen on a chest xray? or as well as a CT of the abdomen and pelvis?

I have had MANY chest xrays in which all have been negative (just had one this past 3 weeks)
I also have had clear abdomen/pelvis's- docs always say my lungs sound good...

My last question is being 27 this is an obvious concern...
Can I die from Sarcoidosis or Sjrojens syndrome?
so if you could please reply to

1. would Sarcoidosis show up on Chest xray?
2. Can I have Sjrojens without have the SSA SSB ? and still be positive with lip biopsy
3. can I die from these?
4. does Plaquenil help Sjrojens? is there anything else I should be doing?
Follow-up: Suffer dry throat, eyes, achy joints, red palms and fatigue. Have high IgG showing polyclonal gammapathy. Suggestions? 4 minutes later
I guess I should also say - I have had chest xrays, CT abdomen/Pelvis multiple times, NOrmal CBC, BMPS , I even had an ECHO about 3 months ago which is fine... (I have a lot of testing due to P.O.T.S)
Answered by Dr. Sandhya Manorenj 28 hours later

First of all I apologise for delay in response.

Q 1) Answer -Of individuals with Sarcoidosis 90% have abnormal findings on Chest X XXXXXXX at some time during their course.

Q 2) answer-Yes it is possible to have sjogrens without SSA/SSB autoantibodies.

The absence of autoantibodies does not exclude the diagnosis of primary sjogrens syndrome. It is based mainly on the anatomopathological findings of a minor salivary gland biopsy.

Biopsy is done to confirm whether it is primary or secondary Sjogrens; to rule out granuloma (seen in sarcoidosis), and lymphoma

Q 3)answer - Primary Sjogrens disease takes 8 to 10 years to develop into full blown disease after the onset of initial symptoms of dry eyes and dry mouth. Survival of patients with sjogrens disease cannot be predicted it depends on manifestation and type of systemic involvement. If sjogrens is due to lymphoma of gland then survival rate is decreased.

Overall prognosis is good in Sarcoidosis. Most individuals who present with acute disease are left with no significant disease. 15-20% of patients the disease remains active or recurs intermittently. Death is attributable directly to the disease in only 10% of all those affected.

Q 4)answer - Plaquenil is helpful for arthralgia in sjogrens syndrome (which you had). Management depend on manifestation. For dryness I have already mentioned. Steroids are indicated if associated with systemic vasculitis.

Hope I have answered your query. Kindly get back if you require any additional information

Above answer was peer-reviewed by
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