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What causes numbness in the hands when diagnosed with connective tissue disease?

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Posted on Wed, 20 Jul 2016
Question: I am a 33-year-old Caucasian married mother of a 2 1/2 year-old.. When baby was three months old, I fell down a long flight of stairs going for diapers in the middle of the night. If you weeks later I developed a bad cold/flu. Right after that I started having tooling in my hands and arms and legs and feet and also dry eyes. I went to an orthopedist in a neurologist. Orthopedist ruled out major injury and suggested physical therapy, which I did. Neurologist's blood work up revealed elevated ANA of 640 and he said that was suspicious for lupus and referred me to a rheumatologist. Metallic just work up showed ANA was still elevated at 160 and was unsure if the symptoms were related to onset of lupus or the back injury.

I have since gone to several rheumatologist who have given me conflicting projections. Some minimize the likelihood of my developing lupus, even though I am in the childbearing range in which lupus typically develops. Others say it is a strong possibility and end with "but if you do develop lupus we have medications to treat." One rheumatologist recommended going on plaquinil now and staying on for two years and "seeing how I do". Others say my risk for developing lupus is minimal since the ANA is reduced. Other than occasional dry eyes, for which they have ruled out Sjogren's at this time I have no other lupus symptoms at this time . Others say "once 640, the possibility of that and it's associated disease risk returning continues."

Needless to say, with a small child I certainly would like to dodge this bullet if possible. The professionals all seem to agree that there is a hormonally related factor in lupus, hence that it attacks mostly childbearing age women, but don't seem to see pregnancy as a trigger for the onset in people who are not yet symptomatic. I do not have a Lupus diagnosis and don't have, at this time, any of the real lupus symptoms. Believe me I become very well-versed in then and am on the alert.

My question is this: my husband and I would both like to have a second child, but neither one of us wants to take the risk of my developing a debilitating disease and not being able to take care of either child. Do you see pregnancy as a possible trigger for bringing on lupus in those who have a positive ANA but no other symptoms?
doctor
Answered by Dr. Naval Mendiratta (1 hour later)
Brief Answer:
Connective tissue disease

Detailed Answer:
Good evening

Thank you for writing on health care magic

I have gone through your history, and to summarize the symptoms :

1. Dry eyes( negative schrimmers I am hoping)
2. Tingling and numbness in the hands , which does seem too debilitating to hamper your daily routine

With a background of strong ANA...

Well, as such it doesnt fit into any connective tissue disease. Sometimes we label it as undifferentiated connective tissue disease but since you dont have any progression or worsening of symptoms, we can just observe as well. At this stage, I wont label it as SLE or Sjogrens...

I would like to know a few more queries, which will be in regard to future pregnancy if you plan:

1. What were the results of ENA Profile

2. Was Lupus anticoagulant, Anti cardilolipin antibody and beta 2 glycoprotein 1 carried out??

3. How about the other blood work??Thyroid profile has been looked at?

As per your query, since you have been stable for almost 2 years now and no new symptoms have come up it may be safe to go ahead with pregnancy..But yes, pregnancy does trigger a lot of autoimmune conditions which may not be present earlier. So to say it will be 100 % Safe, it may be difficult. But that much risk goes for any mother at your age group... Even patients with lupus who have been stable for 6 months, we advise them to plan for pregnancy incase they want..So, as such you are in a good position to plan..

But you need to get these antibodies done once more before planning for pregnancy, as the risk of developing any disease will depend on these autoantibodies...So one needs to be sure that nothing new has evolved and there is no risk to mother or the child...

False positive ANA can be present in 10 % patients...But if further work up is negative, it is safe to go ahead...

Hope the information was useful

Do let me know for more queries and these blood tests if they have been performed

Regards
Dr Naval
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Naval Mendiratta (41 hours later)
Unfortunately my husband and I are traveling and I cannot access my blood results file. I am very certain it is anticoagulant. I have had a complete endocrinology work up. They detected three nodules which they were watching. Two of the nodules disappeared during this past year and another one appeared, none of which are considered problematic. At one point my XXXXXXX ride was considered minimally low and I was prescribed the lowest dosage of levothyroxine. Most recently it has been discontinued. My endocrinologist said if I am planning a pregnancy he would put me on it again.

Despite the fact that my ANA has gone down to 160, I have been told that "once 640 always 640" and that the risk of lupus remains high and that the ANA number remaining positive is what matters. My concern for developing lupus is both for myself and for another child. My 2 1/2 year-old child has been diagnosed with mild apraxia. She is doing great and her delayed speech has almost caught up to her peers. However it is been implicated to me several times that the offspring of women either with diagnose lupus or elevated ANA havevbeen a higher incidence of disability, especially autism. So I am imagining a pregnancy putting myself at risk for a debilitating disease and possibly a child with a disability. Do you think do you offspring of people in my situation have a higher risk of a child with a disability? My husband and I are both professionals and Are seriously considering adoption, although of course I would prefer to carry a child if the risk is minimal. Do you agree that once 640 always 640 , even if the number has declined it is not significant in terms of lowering the risk.? I have been tested four times over the past two years. Moist recently 160 ANA. Thank you very much for your help.
doctor
Answered by Dr. Naval Mendiratta (28 hours later)
Brief Answer:
Is pregnancy safe

Detailed Answer:
good evening

sorry for the late reply.. just travelling with my family.. Well for me to give you a definite answer on the risk, it will depend on the antibody status( ENA profile and the other 3 antibodies)..As such you don't have any symptoms suggestive of Sle.. ANA can be positive with thyroid disease as well as thyroid nodules are usually autoimmune..

pertaining to your queries :

1. as such passing of ANA to your further generation is 0.5% which is almost as good as the risk in population who don't have any ana in family.. So don't worry about that

2. If your ENA profile and antiphospholipid syndrome are negative, the risk of any disease like lupus is lowered.. you should repeat them incase you plan to conceive again..

3. as for adoption, it is a very noble thing to do.. and if your hubby is OK with it you can go ahead with it without having a fear to risk your pregnancy... The place I come from, girls r meant to have pregnancy no matter how what.. but if you both have the understanding you can be tension free and go for adoption straight away

do let me know these results Wen you get back

regards
Dr naval
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Naval Mendiratta

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Practicing since :2007

Answered : 754 Questions

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What causes numbness in the hands when diagnosed with connective tissue disease?

Brief Answer: Connective tissue disease Detailed Answer: Good evening Thank you for writing on health care magic I have gone through your history, and to summarize the symptoms : 1. Dry eyes( negative schrimmers I am hoping) 2. Tingling and numbness in the hands , which does seem too debilitating to hamper your daily routine With a background of strong ANA... Well, as such it doesnt fit into any connective tissue disease. Sometimes we label it as undifferentiated connective tissue disease but since you dont have any progression or worsening of symptoms, we can just observe as well. At this stage, I wont label it as SLE or Sjogrens... I would like to know a few more queries, which will be in regard to future pregnancy if you plan: 1. What were the results of ENA Profile 2. Was Lupus anticoagulant, Anti cardilolipin antibody and beta 2 glycoprotein 1 carried out?? 3. How about the other blood work??Thyroid profile has been looked at? As per your query, since you have been stable for almost 2 years now and no new symptoms have come up it may be safe to go ahead with pregnancy..But yes, pregnancy does trigger a lot of autoimmune conditions which may not be present earlier. So to say it will be 100 % Safe, it may be difficult. But that much risk goes for any mother at your age group... Even patients with lupus who have been stable for 6 months, we advise them to plan for pregnancy incase they want..So, as such you are in a good position to plan.. But you need to get these antibodies done once more before planning for pregnancy, as the risk of developing any disease will depend on these autoantibodies...So one needs to be sure that nothing new has evolved and there is no risk to mother or the child... False positive ANA can be present in 10 % patients...But if further work up is negative, it is safe to go ahead... Hope the information was useful Do let me know for more queries and these blood tests if they have been performed Regards Dr Naval