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Arthritis (Expert Forum)
What's next????
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.
What's next????
by paranoid?, May 07, 2004 12:00AM
Hi, I posted earlier regarding two rashes.
I presented to my dermatolgoist with two rashes, one on my upper right forearm (brown pigemantion) kind of big, and a reddish/purplish rash on my left buttock (covers alot.
I had the rash on my right forearm for years (4 or so), but just noticed the one on my left buttock for maybe a month or so.
Went to the dermatologist, she ordered a lupus package (ANA, C3 & C4 complement, rheumatoid factor, ribosomal P protein Ab). This test came back negative. I got my PCP involved and she ordered a comprehensive metabolic panel, lipid profile, thhyroid screen, CBC, which all came back normal.
The dermatologist biopised the rashes and called me yesterday and told me it was morphea. She told me she wants me to see a rheumologist for further testing to be safe. She said this could affect my organs. Systematic scleroderma.
In 2001, I fractured my left knee. Last year or see the same knee started to hurt and my left foot would tingle. I went to the ortho and he told me nerves were pushing. He injected me with a shot and I was fine.
Well recently it came back. Can this be related to the scleroderma? I read about systematic scleroderma and I don't feel like I have any symptons. Could me presenting with this second rash years later be another sign of systematic scleroderma?
I feel normal other than being depressed about this possible outcome. What do you think?
I presented to my dermatolgoist with two rashes, one on my upper right forearm (brown pigemantion) kind of big, and a reddish/purplish rash on my left buttock (covers alot.
I had the rash on my right forearm for years (4 or so), but just noticed the one on my left buttock for maybe a month or so.
Went to the dermatologist, she ordered a lupus package (ANA, C3 & C4 complement, rheumatoid factor, ribosomal P protein Ab). This test came back negative. I got my PCP involved and she ordered a comprehensive metabolic panel, lipid profile, thhyroid screen, CBC, which all came back normal.
The dermatologist biopised the rashes and called me yesterday and told me it was morphea. She told me she wants me to see a rheumologist for further testing to be safe. She said this could affect my organs. Systematic scleroderma.
In 2001, I fractured my left knee. Last year or see the same knee started to hurt and my left foot would tingle. I went to the ortho and he told me nerves were pushing. He injected me with a shot and I was fine.
Well recently it came back. Can this be related to the scleroderma? I read about systematic scleroderma and I don't feel like I have any symptons. Could me presenting with this second rash years later be another sign of systematic scleroderma?
I feel normal other than being depressed about this possible outcome. What do you think?
Doctor's Answer
by Kevin Pho, MD, May 07, 2004 12:00AM
, May 07, 2004 12:00AM
Morphea, also known as localized scleroderma, is a disorder characterized by thickening and induration of the skin and subcutaneous tissue due to excessive collagen deposition. Morphea subtypes are classified according to their clinical presentation and depth of tissue involvement; they include plaque-type, generalized, linear, and deep varieties. Unlike systemic sclerosis, morphea lacks features, such as sclerodactyly, Raynaud phenomenon, and internal organ involvement.
Most patients with plaque-type morphea experience very gradual (eg, over 3-5 y) spontaneous remission. Therapy with topical or intralesional corticosteroids offers little or limited benefit. Treatment with topical calcipotriene may be attempted.
Patients with generalized, linear, and deep morphea may require more aggressive therapy. Physical therapy to preserve range of motion is of utmost importance. Numerous therapeutic agents have been used, including systemic corticosteroids, antimalarial agents, D-penicillamine, and other anti-inflammatory and immunosuppressive agents. However, no large randomized studies of these agents in patients with morphea exist.
The use of low-dose UV-A phototherapy has produced marked clinical improvement of treated morphea lesions. PUVA bath photochemotherapy has also been reported to be helpful in patients with plaque-type or linear morphea, and PUVA is considered to be one of the best treatment options available.
Severe cases of morphea with elevated ANA and other autoantibody levels have been improved with the use of plasmapheresis.
You may want to discuss these options with your personal physician.
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.
Medical Weblog:
kevinmd_b
Most patients with plaque-type morphea experience very gradual (eg, over 3-5 y) spontaneous remission. Therapy with topical or intralesional corticosteroids offers little or limited benefit. Treatment with topical calcipotriene may be attempted.
Patients with generalized, linear, and deep morphea may require more aggressive therapy. Physical therapy to preserve range of motion is of utmost importance. Numerous therapeutic agents have been used, including systemic corticosteroids, antimalarial agents, D-penicillamine, and other anti-inflammatory and immunosuppressive agents. However, no large randomized studies of these agents in patients with morphea exist.
The use of low-dose UV-A phototherapy has produced marked clinical improvement of treated morphea lesions. PUVA bath photochemotherapy has also been reported to be helpful in patients with plaque-type or linear morphea, and PUVA is considered to be one of the best treatment options available.
Severe cases of morphea with elevated ANA and other autoantibody levels have been improved with the use of plasmapheresis.
You may want to discuss these options with your personal physician.
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.
Medical Weblog:
kevinmd_b
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