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Arthritis (Expert Forum)
Biopsy and Predisolone
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions and support regarding arthritis issues such as: Arthritis, Autoimmune Disease, Bursitis, Fibromyalgia, Gout, Juvenile Rheumatoid Arthritis, Lupus, Myositis, Neuralgia, Osteoarthritis, Polymyalgia Rheumatica, Rheumatoid Arthritis, Sciatica, Tendinitis, Vasculitis.
Biopsy and Predisolone
by Kristina1, Mar 20, 2007 12:00AM
I am a 35 year old mother of 3 (109lb, 57”). After the last pregnancy I started having several symptoms including (joint pains, tiredness, low energy, irritalbe bowl,redness in the skin, red spots in forearms and lower legs, coughed up blood (once in Dec.06 from right lung), red eyes, ear ringing. All blood tests are normal. I am taking 45 mg Prednisolon a day (for almost 3 months), most of the symptoms are better except for the red spots, redness in the skin, red eyes and ear ringing which some times improve sometimes not. The Doctors are not sure what I have but they think a form of Vasculites.
I am scheduled for a muscle/vessels biopsy to see if there is inflammation of the vessels. BUT: Is the result going to be reliable even if I am taking the Prednisolon?
If the test shows not inflammation it's because I do not have Vasculitis or because I am taking the medication?
My doctor is not sure.
I am scheduled for a muscle/vessels biopsy to see if there is inflammation of the vessels. BUT: Is the result going to be reliable even if I am taking the Prednisolon?
If the test shows not inflammation it's because I do not have Vasculitis or because I am taking the medication?
My doctor is not sure.
Doctor's Answer
by Kevin Pho, MD, Mar 20, 2007 12:00AM
, Mar 20, 2007 12:00AM
I agree with the biopsy as the next step. The results should be diagnostic despite taking prednisone - as it is the most definitive test.
If the result is not conclusive, there is a possibility that the biopsy did not sample the appropriate lesion. Repeating the biopsy can be considered in this case. Consecutive negative tests would make the possibility of vasculitis less likely.
I am not aware of prednisone affecting the result - however this should be discussed with your physician prior to the test.
These options can be discussed with your personal physician, or in conjunction with a rheumatologist.
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_
If the result is not conclusive, there is a possibility that the biopsy did not sample the appropriate lesion. Repeating the biopsy can be considered in this case. Consecutive negative tests would make the possibility of vasculitis less likely.
I am not aware of prednisone affecting the result - however this should be discussed with your physician prior to the test.
These options can be discussed with your personal physician, or in conjunction with a rheumatologist.
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_
Thank you
Cindy
I think too that my doctor is not doing everything right.
I figured the right way and timing to take my medicine only 2 months after I was taking it.
I guess they hope to see something because I still have some symptoms..which is scaring me soo much because I am already taking strong medications.
Thanks,
Cristina
Yes, I think a new dr is definitely a must. Also, if you are still having symptoms, they may still find something, but it will be much harder to find on steroids. Also vasculitis is not continuous in your tissues often, so you can have sampling errors, where they get the wrong spot. Completely diseased tissue can be right beside normal tissue. Which is more likely on steroids because you are on treatment that will supress your reaction. SO you may still be having vasculitis but not as widespread, and that makes a sampling error more likely. If it were me ( since you know you need a biopsy,) I would tell the drs you want to be off steroids for at least a few weeks. If everything starts falling apart quickly and you need to get back on steroids, you can get a sample knowing the disease is increasing in activity and this would increase the likelihood of getting what is going on in the tissues. This is the advice we have gotten from the top experts, to wait a few weeks on very low dose or no steroids before biospy. The biopsies are so hard to get the right sample sometimes, I just would want to know they are taking biospies with the most chance of getting the right spot. Good luck.
Cindy