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Suggest Treatment For Mild Neuropathy And Memory Issues
Question: I am seeing a neurologist and evaluating mild neuropathy and difficulty with memory; recent chest pain and shortness of breath in emergency room, no cause found (CPK 200); raynauds in the winter
New findings of ANA 1:360 and antiDs DNA 31 in borderline range-would borderline antiDs DNA still be possible with lupus?
New findings of ANA 1:360 and antiDs DNA 31 in borderline range-would borderline antiDs DNA still be possible with lupus?
Brief Answer:
Is it connective tissue disease
Detailed Answer:
Good evening
Thank you for writing on health care magic
Well, you have multiple symptoms coming up all of a sudden.. I would like to know a few more details, as it would give me a clearer picture on what exactly is going on....
1. Neuropathy: Is is possible for you to attach the NCV report. Would like to see if it is axonal or demyelinating and the pattern of it...As the neuropathy do have a typical pattern when they come with autoimmune diseases...
2. Raynauds at this age is usually not primary. It has to go with the Strong ANA titre you have.
3. Shortness of breath and chest pain: Where was the chest pain location? Did it get worse with breathing..??
4. Any other history of oral ulcers/fatigue/dry eyes/dry mouth/hair fall/rashes/photosenstivity
5. Has your CBc, ESR, Renal function, liver function and ENA profile been looked at...?
DsDna is not specific for lupus.. If you have all these symptoms with ANA strong positive, we can still go in favor of lupus. But yes the treatment will differ according to the organ involvement.
Do let me know these queries.Would guide you further from here
regards
Dr naval
Is it connective tissue disease
Detailed Answer:
Good evening
Thank you for writing on health care magic
Well, you have multiple symptoms coming up all of a sudden.. I would like to know a few more details, as it would give me a clearer picture on what exactly is going on....
1. Neuropathy: Is is possible for you to attach the NCV report. Would like to see if it is axonal or demyelinating and the pattern of it...As the neuropathy do have a typical pattern when they come with autoimmune diseases...
2. Raynauds at this age is usually not primary. It has to go with the Strong ANA titre you have.
3. Shortness of breath and chest pain: Where was the chest pain location? Did it get worse with breathing..??
4. Any other history of oral ulcers/fatigue/dry eyes/dry mouth/hair fall/rashes/photosenstivity
5. Has your CBc, ESR, Renal function, liver function and ENA profile been looked at...?
DsDna is not specific for lupus.. If you have all these symptoms with ANA strong positive, we can still go in favor of lupus. But yes the treatment will differ according to the organ involvement.
Do let me know these queries.Would guide you further from here
regards
Dr naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your answer.
The raynauds has been present for over 10 years.
THere was no emg done, the MRI of the brain with contrast was negative and the neurologist did not feel there were findings to insist on having it done. They are the least troublesome issue. The memory and cognitive changes have been rapid over the last 2 years but no other neurological changes on exam or imaging has been noted.
The shortness of breath was one incident with severe left sided pressure and pain in the left posterior lower rib area- it felt like a concrete block was sitting against the lung preventing a deep breath. Chest xray and CT scan, troponins were negative. no fever.
Yes to rashes intermittently (dont recall a malar rash), painful tiny nodules on the knuckles that spontaneously come and go; photosensitivity with sun exposure and sometimes dry eyes. Also over the last 2 years choke more on food. One month ago during a bronchitis episode i woke up aspirating and choking on gastric secretions.
They all seem disconnected, but may be of significance in context!
cbc has also shown wbc between 3 and 6 over last 10 years. ESR slightly elevated, lft and renal function are normal. Complement and SPEP were normal.
fatigue is constant. but so is escalating age ( I was an avid dance/aerobics enthusiaast, still go 3-4 times per week, which has helped mood and all else but that has been more challenging lately.
Thankyou
The raynauds has been present for over 10 years.
THere was no emg done, the MRI of the brain with contrast was negative and the neurologist did not feel there were findings to insist on having it done. They are the least troublesome issue. The memory and cognitive changes have been rapid over the last 2 years but no other neurological changes on exam or imaging has been noted.
The shortness of breath was one incident with severe left sided pressure and pain in the left posterior lower rib area- it felt like a concrete block was sitting against the lung preventing a deep breath. Chest xray and CT scan, troponins were negative. no fever.
Yes to rashes intermittently (dont recall a malar rash), painful tiny nodules on the knuckles that spontaneously come and go; photosensitivity with sun exposure and sometimes dry eyes. Also over the last 2 years choke more on food. One month ago during a bronchitis episode i woke up aspirating and choking on gastric secretions.
They all seem disconnected, but may be of significance in context!
cbc has also shown wbc between 3 and 6 over last 10 years. ESR slightly elevated, lft and renal function are normal. Complement and SPEP were normal.
fatigue is constant. but so is escalating age ( I was an avid dance/aerobics enthusiaast, still go 3-4 times per week, which has helped mood and all else but that has been more challenging lately.
Thankyou
Brief Answer:
Further course
Detailed Answer:
Good evening
Sorry for the delayed reply...Had a long duty.
Thanks for your reply. As per your symptoms, I won't say it totally fits in with SLE. But yes some of them do...
1. Raynauds
2. History of chest pain( It was probably pleurisy)
3. Photosensitivity
4. Dry eyes
5. ANA positive
But since the other tests have been normal for the internal organs, it may be just a minor organ Lupus...But yes I would like to see the ENA profile which will confirm our diagnosis and give us a clue where we are heading...But yes for these symptoms,I would have started you on Hydroxychloroquine. As such a safe drug and will help further prevention of the disease
Secondly..Few of the symptoms may be pointing towards other illness called Fibromyalgia. Given a background of depression, this disease can very well come along...The symptoms of fatigue, irritability, decreased sleep, bodyaches can all go with it...I would suggest you log on www.rheumatology.org--> Patient information--> Fibromyalgia.. and see if your symptoms match...The management does differ for it..But I would suggest we treat both, so your quality of life can improve
Do let me know once you go through this
regards
Dr Naval
Further course
Detailed Answer:
Good evening
Sorry for the delayed reply...Had a long duty.
Thanks for your reply. As per your symptoms, I won't say it totally fits in with SLE. But yes some of them do...
1. Raynauds
2. History of chest pain( It was probably pleurisy)
3. Photosensitivity
4. Dry eyes
5. ANA positive
But since the other tests have been normal for the internal organs, it may be just a minor organ Lupus...But yes I would like to see the ENA profile which will confirm our diagnosis and give us a clue where we are heading...But yes for these symptoms,I would have started you on Hydroxychloroquine. As such a safe drug and will help further prevention of the disease
Secondly..Few of the symptoms may be pointing towards other illness called Fibromyalgia. Given a background of depression, this disease can very well come along...The symptoms of fatigue, irritability, decreased sleep, bodyaches can all go with it...I would suggest you log on www.rheumatology.org--> Patient information--> Fibromyalgia.. and see if your symptoms match...The management does differ for it..But I would suggest we treat both, so your quality of life can improve
Do let me know once you go through this
regards
Dr Naval
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Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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