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Arthritis (Expert Forum)
Possible Wegener's Granulomatosis
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
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Possible Wegener's Granulomatosis
by Metalroof, Jul 14, 2004 12:00AM
I am a 40 yr old male with increasingly confusing health issues. None of my local drs seem to see any need to pull all of my weird things together and I am wondering what you think.
I have for several years battled a chronic cough. It is worst in the winter. This summer though I have still struggled some with it and I also have periodic hoarseness which comes along with it. Last winter, I was diagnosed with very mild asthma. However, the std asthma meds did not help. The only things that seemed to bring me out of what was a constant cough last winter were a 20-day course of prednisone (started at 20 mg) and warmer weather.
I have fought sinus problems for many yrs. If I did not do nasal irrigation at least twice a day and also use lots of saline nasal spray I would really be in trouble with nasal discharge and sinus infections. I always takes Allegra D and I use Rhinocort Aqua.
I was diagnosed several years ago with fibromyalgia. For many years I have battled muscle soreness esp in the mornings. It actually has been better the last few years but I am horribly tired constantly. I have gone through a sleep study and it did not show apnea but they sais that I wake myself up snoring a lot and do not get into the deeper level of sleep enough. I am so tired that I can sometimes fall asleep 15 - 20 times on a 20 minute drive to and from work.
Last November I went through a 3 week period when my left leg from the knee down became incredibly painful. It was hard to walk and it really hurt to touch it. Celebrex and Flexeril helped. I did go through checks for blood clots but they were negative. Then the pain went away almost as quickly as it came.
I have also had ear problems for 2 - 3 yrs. It started with mild ear drainage at night which resulted in yeast infections. I still have some drainage most nights, resulting in crusty and scaly "stuff" in my ears. Last winter, my ears completely plugged and I had a tube put in one of them, which resulted in a real mess of drainage for about two weeks.
Most recently, for the past 8 months or so, my eyes have been increasingly bloodshot during the day and they burn and itch. Additionally, when I get up in the mornings, it looks like I have pink eye but that clears after awhile. There is no discharge from them. My eye doctors have tried artifical tears, cortisone drops, and allergy drops and nothing seems to help. My left eye is worst.
Last fall I had CT scans of sinuses and chest and they were okay. I also check my urine occasionally for blood and protein and it is okay. I have had thyroid checked and it was okay, though slightly high on T3. A CBC was okay except for a slightly elevated liver enzyme. My doctor, last fall, ran an ANCA test and it was okay.
My drs see no reason to pursue the possibility of Limited WG. I am not sure they are familiar with "Limited" WG though.
I am about 4 hrs from Cleveland; would I be wasting Dr Hoffman's time to go see him and be evaluated for WG? Thanks!
I have for several years battled a chronic cough. It is worst in the winter. This summer though I have still struggled some with it and I also have periodic hoarseness which comes along with it. Last winter, I was diagnosed with very mild asthma. However, the std asthma meds did not help. The only things that seemed to bring me out of what was a constant cough last winter were a 20-day course of prednisone (started at 20 mg) and warmer weather.
I have fought sinus problems for many yrs. If I did not do nasal irrigation at least twice a day and also use lots of saline nasal spray I would really be in trouble with nasal discharge and sinus infections. I always takes Allegra D and I use Rhinocort Aqua.
I was diagnosed several years ago with fibromyalgia. For many years I have battled muscle soreness esp in the mornings. It actually has been better the last few years but I am horribly tired constantly. I have gone through a sleep study and it did not show apnea but they sais that I wake myself up snoring a lot and do not get into the deeper level of sleep enough. I am so tired that I can sometimes fall asleep 15 - 20 times on a 20 minute drive to and from work.
Last November I went through a 3 week period when my left leg from the knee down became incredibly painful. It was hard to walk and it really hurt to touch it. Celebrex and Flexeril helped. I did go through checks for blood clots but they were negative. Then the pain went away almost as quickly as it came.
I have also had ear problems for 2 - 3 yrs. It started with mild ear drainage at night which resulted in yeast infections. I still have some drainage most nights, resulting in crusty and scaly "stuff" in my ears. Last winter, my ears completely plugged and I had a tube put in one of them, which resulted in a real mess of drainage for about two weeks.
Most recently, for the past 8 months or so, my eyes have been increasingly bloodshot during the day and they burn and itch. Additionally, when I get up in the mornings, it looks like I have pink eye but that clears after awhile. There is no discharge from them. My eye doctors have tried artifical tears, cortisone drops, and allergy drops and nothing seems to help. My left eye is worst.
Last fall I had CT scans of sinuses and chest and they were okay. I also check my urine occasionally for blood and protein and it is okay. I have had thyroid checked and it was okay, though slightly high on T3. A CBC was okay except for a slightly elevated liver enzyme. My doctor, last fall, ran an ANCA test and it was okay.
My drs see no reason to pursue the possibility of Limited WG. I am not sure they are familiar with "Limited" WG though.
I am about 4 hrs from Cleveland; would I be wasting Dr Hoffman's time to go see him and be evaluated for WG? Thanks!
Doctor's Answer
by Kevin Pho, MD, Jul 16, 2004 12:00AM
, Jul 16, 2004 12:00AM
The most common clinical symptoms of WG would include persistent rhinorrhea, purulent/bloody nasal discharge, oral and/or nasal ulcers, polyarthralgias, myalgias, or sinus pain. Less common symptoms of upper airway involvement are hoarseness, stridor, earache, hearing loss, or otorrhea.
Nonspecific complaints of fever, night sweats, anorexia, weight loss, and malaise may accompany upper or lower airway disease. In addition, signs and symptoms related to involvement of other organ systems may also be seen. These include ocular inflammation, nasal congestion, joint tenderness and or effusion, and rash. Skin lesions include palpable purpura, ulcers, vesicles, papules, and subcutaneous nodules.
You are correct to imply that limited WG can be possible despite a negative ANCA test. The sensitivity of the ANCA is only 65-70 percent in these cases, and may miss the diagnosis.
If there continues to be suspicion, I would go ahead with the rheumatology evaluation to evaluate for the possibility of limited WG.
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
Bibliography:
Rose et al. Clinical manifestations and diagnosis of Wegener's granulomatosis and microscopic polyangiitis. UptoDate, 2004.
Nonspecific complaints of fever, night sweats, anorexia, weight loss, and malaise may accompany upper or lower airway disease. In addition, signs and symptoms related to involvement of other organ systems may also be seen. These include ocular inflammation, nasal congestion, joint tenderness and or effusion, and rash. Skin lesions include palpable purpura, ulcers, vesicles, papules, and subcutaneous nodules.
You are correct to imply that limited WG can be possible despite a negative ANCA test. The sensitivity of the ANCA is only 65-70 percent in these cases, and may miss the diagnosis.
If there continues to be suspicion, I would go ahead with the rheumatology evaluation to evaluate for the possibility of limited WG.
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
Bibliography:
Rose et al. Clinical manifestations and diagnosis of Wegener's granulomatosis and microscopic polyangiitis. UptoDate, 2004.
I need some help! I've been experiencing hand, feet, and joint pain. It's been real bad for about 2 weeks now. I went to my MD and he thinks I might have RA and gave me Bextra to take and it's not working!! He is sending me to a Rheumatologist and My appointment is not till the end of Sept. What can I do for now to keep the pain at bay? Any suggestion would be appreciated.
39 male NY
Best wishes to all,
jamit_a