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Arthritis (Expert Forum)
Autoimmune??
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
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.
Autoimmune??
by jlr52629, Sep 29, 2006 12:00AM
Antiphospholipid Antibody Panel:
Beta-2 Glycoprotein I (IGM) 17 (Normal is <10)
Phosphatydylserine AB IGM >100 (Normal is <25)
Cardiolipin AB (IGM) 22 (Normal is <10)
Lupus Anticoagulant:
PTT-LA 41 (Normal is <40) (But she said that this one doesn't mean anything because the DRVVT Screen came back normal.)
Absolute Eosinophils 599 (Normal 15-500)
EEG – There is considerable generalized slowing on hyperventilation; these changes may at times be a normal variant in young adults, however, a sleep-deprived EEG is recommended. No focal slowing is noted. BAER – Normal VER – Normal
EMG of left arm – Normal. Two pinched nerves.
MRI of Brain – There are multiple areas of increased T2 and inversion recovery signal, white matter abnormal signal within the subcortical white matter of both frontal lobes. A few foci of abnormal T2 signal are also present within the remainder of the brain as well.
MRI of the Cervical Spine w/wo Contrast – 1. Small left central disc protrusion at C4-5 with mild canal stenosis and foraminal stenosis on the left. 2. Small posterior central disc extrusion at C5-6 with mild canal stenosis. 3. Desiccated bulging disc with small posterior central disc extrusion at C6-7 causing mild canal stenosis. 4. No abnormal enhancement. No focal lesion is seen within the cord.
MRI of the thoracic Spine without Contrast – 1. Mild degenerative bulging discs from T5 through T9. 2. No disc protrusions or canal stenosis in the thoracic spine.
MRA of the Circle of Willis – Normal
MRA of the Bilateral Carotid Arteries with Contrast – Normal
Neck and upper back pain, aching, burning muscles and joints throughout the body, headaches, fatigue, constant ringing in both ears, extreme mood changes.
My Neurologist thinks the cardiolipin is causing the brain MRI abnormalities and that I should take an aspirin a day and repeat MRI in a year. He also prescribed Ativan which I am not taking because I read that it is highly addictive. My Hematologist thinks he's wrong and that it's something autoimmune and that a year is too long to wait. Any thoughts?
Beta-2 Glycoprotein I (IGM) 17 (Normal is <10)
Phosphatydylserine AB IGM >100 (Normal is <25)
Cardiolipin AB (IGM) 22 (Normal is <10)
Lupus Anticoagulant:
PTT-LA 41 (Normal is <40) (But she said that this one doesn't mean anything because the DRVVT Screen came back normal.)
Absolute Eosinophils 599 (Normal 15-500)
EEG – There is considerable generalized slowing on hyperventilation; these changes may at times be a normal variant in young adults, however, a sleep-deprived EEG is recommended. No focal slowing is noted. BAER – Normal VER – Normal
EMG of left arm – Normal. Two pinched nerves.
MRI of Brain – There are multiple areas of increased T2 and inversion recovery signal, white matter abnormal signal within the subcortical white matter of both frontal lobes. A few foci of abnormal T2 signal are also present within the remainder of the brain as well.
MRI of the Cervical Spine w/wo Contrast – 1. Small left central disc protrusion at C4-5 with mild canal stenosis and foraminal stenosis on the left. 2. Small posterior central disc extrusion at C5-6 with mild canal stenosis. 3. Desiccated bulging disc with small posterior central disc extrusion at C6-7 causing mild canal stenosis. 4. No abnormal enhancement. No focal lesion is seen within the cord.
MRI of the thoracic Spine without Contrast – 1. Mild degenerative bulging discs from T5 through T9. 2. No disc protrusions or canal stenosis in the thoracic spine.
MRA of the Circle of Willis – Normal
MRA of the Bilateral Carotid Arteries with Contrast – Normal
Neck and upper back pain, aching, burning muscles and joints throughout the body, headaches, fatigue, constant ringing in both ears, extreme mood changes.
My Neurologist thinks the cardiolipin is causing the brain MRI abnormalities and that I should take an aspirin a day and repeat MRI in a year. He also prescribed Ativan which I am not taking because I read that it is highly addictive. My Hematologist thinks he's wrong and that it's something autoimmune and that a year is too long to wait. Any thoughts?
Doctor's Answer
by Kevin Pho, MD, Sep 30, 2006 12:00AM
, Sep 30, 2006 12:00AM
I would obtain a referral to a rheumatologist for a 3rd opinion.
There is evidence of a hypercoagulable state with the tests - putting you at risk of future blood clots. I agree with the aspirin recommendation.
I cannot comment on when to repeat the MRI without evaluation. A referral to a rheumatologist, or 2nd neurological opinion, can be considered to obtain a more concrete recommendation.
Ativan can be habit-forming if regularly used. However, it is relative safe if used occasionally and monitored by your 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.
kevinmd_
There is evidence of a hypercoagulable state with the tests - putting you at risk of future blood clots. I agree with the aspirin recommendation.
I cannot comment on when to repeat the MRI without evaluation. A referral to a rheumatologist, or 2nd neurological opinion, can be considered to obtain a more concrete recommendation.
Ativan can be habit-forming if regularly used. However, it is relative safe if used occasionally and monitored by your 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.
kevinmd_
ANA Screen, Rheumatoid Factor, C-Reactive Protein