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Arthritis (Expert Forum)
differential diagnosis - can sle mimic ms to this degree?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
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differential diagnosis - can sle mimic ms to this degree?
by blb, Feb 28, 2007 12:00AM
I experience symptoms which seem consistent with MS. These include arm,hand/wrist weakness, spastic movements, clonus, and difficulty with fine-motor skills. Though I have some daily impairment, I definitely experience periods of acute exacerbation. Recently, I have developed some gait abnormalities (balance difficulties when walking in dark rooms and a tendancy to walk either on the balls of my feet, or very stiffly, when I am walking barefoot on hard surfaces.)
MRI - 6 years ago = "several areas of hyperintense signal."
1 year ago = "no change in previous pattern"..."several new
areas of hyperintense signal" (predominantly
subcortical white matter - some periventrical
- possibly one in corpus collosum.)
Csf - 6 years ago = no oligoclonal bands
elevated immunoglobulins
Blood work: 1 year ago = elevated ana (1:160)
elevated ana-eia (2.2, normal = <.9)
elevated dsDNA (44, normal = <34)
Despite being seen at a respected teaching hospital, differential diagnosis proves difficult - neurology refers me to rheumatology; rheumatology refers me back to neurology. Can SLE or other rheumatological condition mimic MS to this degree?
MRI - 6 years ago = "several areas of hyperintense signal."
1 year ago = "no change in previous pattern"..."several new
areas of hyperintense signal" (predominantly
subcortical white matter - some periventrical
- possibly one in corpus collosum.)
Csf - 6 years ago = no oligoclonal bands
elevated immunoglobulins
Blood work: 1 year ago = elevated ana (1:160)
elevated ana-eia (2.2, normal = <.9)
elevated dsDNA (44, normal = <34)
Despite being seen at a respected teaching hospital, differential diagnosis proves difficult - neurology refers me to rheumatology; rheumatology refers me back to neurology. Can SLE or other rheumatological condition mimic MS to this degree?
Doctor's Answer
by Kevin Pho, MD, Mar 01, 2007 12:00AM
, Mar 01, 2007 12:00AM
There are some overlapping syndromes between the two diseases. At this time, with the negative CSF fluid and MRI, MS would seem to be less likely.
Evoked potentials and antimyelin antibodies would be two more specialized tests that can further rule out MS. If these tests are negative, I would focus more on a rheumatological disease. This is especially true in light of the elevated ANA and elevated dsDNA.
A second rheumatological opinion can be obtained if the diagnosis continues to be non-revealing.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
Evoked potentials and antimyelin antibodies would be two more specialized tests that can further rule out MS. If these tests are negative, I would focus more on a rheumatological disease. This is especially true in light of the elevated ANA and elevated dsDNA.
A second rheumatological opinion can be obtained if the diagnosis continues to be non-revealing.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
