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Arthritis (Expert Forum)
could this be lupus related?
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.
could this be lupus related?
by imbabsj, Jul 24, 2005 12:00AM
I was diagnosed with lupus 12 yr ago. Early years I had the arthritis type problems and extreme fatigue and optic neuritis bilaterally. After all the labs I eventually was rx as lupus not MS. Things got worse over the years including a inflamed pancreas(i don't or ever drink) then 3 yr ago a autoimmune hepatitis which was lupus related Nearly died but eventually responded well to pred. At 4yr old I had a large tumor on my liver and had a liver resection. Evidently I started out with problems early in life. I am now 58 and am being treated with plaquenile 200mg and celebrex 200 along with normadyne and norvasc, prozac and asthma drugs (late onset asthma). I caught a virus or bacteria 2yr ago that led to a sinus infection that started a long term on and off infection process. I had not been off prednisone very long mayby 8 mo. Along with that an excessive phlemg/mucus production also began at that time and has continued to get worse. Iv'e been to ENT's and Allergiests (no allergy found) have been on every antihistimine RX I can safely take with high blood pressure and use flonase and astelin. I have a small deviation on right side of nasal no ployps just major phlemg. I'm choking all the time I use mucinex 3x a day and still can't handle all the flow. My right side is the problem I can feel it piling up and chocking me I use nasal washes salt water helps some but this is overwhelming. i have to use a oral pik and tongue cleaner to drag the junk out. I get thick bands of plemgh that I have to break with the pik to open my throat. It'a nightmare.My Rheumatologist is trying to help by putting me on methotrexate 2.5mg 3-4 per week. I'm very sensitive too prednisone and blow up fast hence the choice of methotrexate. I just started it and wonder if and how long I should wait to expect to see any results. I'm in trouble and my ins.(medicaid) declines sinus surg. I could appeal but my Ent felt it could help manage problem but not neceessarily solve. So I went to my Rheumy who knows me and my case for help. I'm up several times during the night choking & coughing out plemgh and several times a day. I basically can't leave the house anymore. ent says there is a small %of people that have this problem that won't respond to therapy. I'm desperate and feel like I'm in crisis. my Rheumy put me on clonazapam 0.5 2xd to help calm me. This is all new to me I never suffered sinus problems before thats why I'm perplexed. Mayby 3-4 sinus inf in my life got antibiotics and was fine. No one seems to know what to do for me.Have you ever heard of such a problem with a lupus pt? My rheumy has but I don't know if anyone was helped with methotrexate.I hate to go on prednisone but if thats all that will help I have to do something I basically have no live right now. I'm a person that desperately wants to well.My voice is permantely hoarse. Any comments or help or suggestions greatly apprecieated.Need Advice! PS My Rheumy is top notch use to be professor at UofMi med CTr.
Doctor's Answer
by Kevin Pho, MD, Jul 26, 2005 12:00AM
, Jul 26, 2005 12:00AM
You have been through a pretty comprehensive evaluation with several evaluations with ENTs and allergists.
Unfortunately for these refractory cases, steroids like prednisone can help - and certainly can be tried again if the other regimens fail.
Various antibiotics can be tried on a more chronic basis. You can start with something relatively broad-spectrum like a quinolone (i.e. Levaquin). Imaging with a CT scan can also be done to further evaluate the sinuses.
There are very atypical cases of cystic fibrosis that can present later on in life. This can lead to increased mucous production. If this is a consideration, a sweat chloride test would be done.
Although possible, I am not aware of these symptoms being associated with lupus.
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.
http://www.straightfromthedoc.com
Unfortunately for these refractory cases, steroids like prednisone can help - and certainly can be tried again if the other regimens fail.
Various antibiotics can be tried on a more chronic basis. You can start with something relatively broad-spectrum like a quinolone (i.e. Levaquin). Imaging with a CT scan can also be done to further evaluate the sinuses.
There are very atypical cases of cystic fibrosis that can present later on in life. This can lead to increased mucous production. If this is a consideration, a sweat chloride test would be done.
Although possible, I am not aware of these symptoms being associated with lupus.
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.
http://www.straightfromthedoc.com
Member Comments
by beebug, Aug 16, 2005 12:00AM
I have been diagnosed with Osteoarthritis with Lupus variable, whatever that means. My doctor has me on Plaquenil 200 mg. twice a day and Voltaren, 50 miligrams twice a day. My creatine level is slightly elevated. Could this be part of the lupus?
