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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes feeling lump in throat?

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Dr. Alokkalyani

Rheumatologist

Practicing since :1999

Answered : 517 Questions

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Posted on Tue, 5 Aug 2014 in Lupus
Question: Went to see a new internal med dr today to get some information on my general health concerns

Discussed pos Ana that I've had for two years now . The numbers ranged from 1:640 to 1:1120 and at one reading was 1:320 homogeneous pattern , histones ranged from 1.7 to 4. Have been to 2 rheumatogists and all tests they ran for autoimmune were neg. I have some joint pain in my fingers knees and ankles and wrists that comes and goes. I do exercise everyday and have been for over thirty years. Have lower disc herniations and some back pain and leg muscle pain. I take one baby aspirin a day and it helps.

I was also on cymbalta since 9/2011 but stopped it four months ago because of major hairloss .

I was taking it for anxiety and back issues. I have arthritis in my left big toe and I think the left toe next to the big toe is starting to hurt . I have had acid reflux and was on medication twice last year.

My symptoms were a lump in my throat on 5/2013 and after I did an endoscopy in 10/13 I went on it again.

I feel now that when I eat a heavy meal a I get that lump again.

The internal med dr said I'm perfectly healthy for now based on all lab work and tests I have done.and to cont doing bloodwork to check for autoimmune.

I have some dyspnea also the past seven months I did pft and seeing XXXXXXX monologist this week to go over.
doctor
Answered by Dr. Alokkalyani 51 minutes later
Brief Answer:
follow your physician

Detailed Answer:
Hi and thanks for the query

I am Dr. Alok and very pleased to be assisting you with your health questions today.

you must understand that all investigations are considered only in context of clinical history and exam, so if your physician is saying that your are healthy, there is no need to be anxious. Even if you have ANA positive and arthralgia, doesnot mean that you have disease.

Hope this helps and provides answers to your question.
If you have any further queries, please don’t hesitate to ask me again
I wish you good health, take care
--Dr. Alok
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Alokkalyani 9 hours later
does the ana number coincide with the severity of the disease if there is a disease. otherwise the high the number the more damage the disease is afflicting.
also can one have a high ana and all other autoimmune antibodies be negative in the beginning of a disease and later on show up. if one has
high ana and symptoms of autoimmune , and other blood work is run for other antibodies do they usually show up to make the diagnosis even more definitive.
for example a patient with lupus as some of the symptoms and blood work is run , the ana tests positive then all the other lupus antibody tests are run. would they usually show something?
doctor
Answered by Dr. Alokkalyani 23 minutes later
Brief Answer:
no

Detailed Answer:
Hi,

ANA number is NOT coincide with the severity of the disease. It is also not related to damage.

also can one have a high ana and all other autoimmune antibodies be negative in the beginning of a disease and later on show up. -- Yes it may be possible

If one has high ana and symptoms of autoimmune , and other blood work is run for other antibodies do they usually show up to make the diagnosis even more definitive.--YES
for example a patient with lupus as some of the symptoms and blood work is run , the ana tests positive then all the other lupus antibody tests are run. would they usually show something? - YES, it is called as ENA profile and it is helpful in further delineating the diseases.

take care
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Alokkalyani 12 hours later
My other question was also can Ana go from negative to a high of 1:640 in a year?
Is the pattern usually a good determinant of the kind of autoimmune.?
Mine was homogeneous.
Could the cymbalta be causing my Ana to increase?
One more thing in systemic sclerosis the limited kind,how long does it take for skin thickening to occur
doctor
Answered by Dr. Alokkalyani 2 hours later
Brief Answer:
yes

Detailed Answer:

My other question was also can Ana go from negative to a high of 1:640 in a year? yes it might be possible, I have seen few patients where previous ANA was negative or weekly positive initially

Is the pattern usually a good determinant of the kind of autoimmune? -- I am not able to understand this question

Could the cymbalta be causing my ANA to increase? -- NO

Regarding your last question, it is very difficult to predict the time period to develop thickening of skin, but mostly it is a very slow process, years to take before developing any obvious change.

Take care

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Alokkalyani 5 hours later
The ana titer pattern, homogeneous,nucleolar,speckled, centromere. mine was homogeneous, which they say can be lupus or drug induced lupus.
that is what i mean. does the ana pattern usually coincide with the autoimmune disease?
also, have you seen people with pos ana for many years and still remain healthy, meaning no autoimmune symptoms? please be honest.
can autoimmune cause damage to your lungs in 2 years time?
I told you had dyspnea for the last 7 months. going to pulmonary doctor tomorrow to go over pulmonary function tests.
doctor
Answered by Dr. Alokkalyani 4 hours later
Brief Answer:
yes

Detailed Answer:
Usually drug induced lupus have homogenous pattern and carrying antihistone antibodies. But this pattern is not related with autoimmune disease

I do not ask my patients to come for followup if there is on disease but just positive ANA. So I am not able to give exact figures based on my experience. But as per literature, 5-10 % people have positive ANA but remain normal in their life.

Can autoimmune cause damage to your lungs in 2 years time?
--- it really depends on severity of disease, but as I told you, this is a slow progressive disease. If you have concern, you are on the right tract now. You should see your physician for pulmonary function test.

Regards


Above answer was peer-reviewed by : Dr. Prasad
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