Biopsy and Predisolone

[Kristina1]

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.

[Kevin Pho, MD]

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_

[Kristina1]

The doctor explained that the muscle biopsy will leave a scar and a 1cm hole in my right leg…How can one do multiple biopsy?  I have many veins and capillaries in my left leg (consequence of the pregnancies), can’t those be tested without taking muscle?
Thank you

[CINDY4]

Hi, As a mom to a daughter who has had Churg-Strauss vasculitis for the past 5-6 years, I have to tell you the prednisone (or prednisolone) will absolutely affect the biopsy. You are on a high dose of streoids and if you have been on that dose for almost an entire 3 months solid, it will affect your biospy to some degree or another. You are being treated pretty aggressively, it would be unlikely unless the disease is some what unresponsive to still find active vasculitis on biopsies. It may well be that you are not responding completely as it sounds like you are still having vasculitis symptoms, and therefore you may still have some degree of inflammation show up, but you can be certain that the disease will not be at the level it was before any treatment. I wonder why your drs would treat you with high dose steroids for presumed vasculitis without doing a biopsy before treatment, and now 3 months later want the biopsy, that is just not the way things are done unless you are in a life threatening situation and are too unstable for a biopsy . I think the dr that answers these posts is usually right, but it is hard to believe any doctor would not be aware that prednisone would not affect biopsy results for an inflammatory disease like vasculitis, as predisone or prednisolone as you mention are amoung the most potent anti-inflammatory immunosupressant drugs used in these diseases. With my daughter we have taken her to the experts in vasculitis, and if you really do have it, you probably need to go to one of the vasculitis centers. These are serious diseases that are difficult to treat, and are treated with serious drugs. You need a dr that knows what they are doing, and so far it does not sound like you are getting the best advice for diagnosing and treating this. We go to the Cleveland CLinic, but the Mayo, and John's Hopkins all have centers for vasculitis. I have to tell you the whole issue of steroids and biospies has been a constant struggle with treating my daughter. She will have symptoms as we lower her steroids, but because she has been on them so long they "mask" biospies and lab work. (Yes, blood work also can be affected, and steroids can "mask" it too),. So we will wean the steroids as low as possible until the symtpoms are terrible, to let it build up to see what is going on in the tissues, because it takes at least 6-8 weeks to get long term high dose steroids out of your system enough to get fairly accurate biopsies. This advice comes straight from the leading experts in the nation. We have seen many of the best drs because this is so rare in a child, and it has taken a lot of biopsies, and many great minds to figure it out, and the steroids and biospies always came up no matter what dr we were seeing. Good luck, and find a dr that really knows what he is doing!

Cindy

[Kristina1]

Thank you for the info.
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

[CINDY4]

Christina,

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