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Doctor Q&A for Dr. Alfred Kim

A 34-year-old female asked:
Dr. Alfred Kim
Rheumatology 16 years experience
Depends on symptoms: ANA is a screen for lupus. The pattern was used in the past to assist in diagnosing lupus and related conditions, but we have better tests (i.e. Ena panel) that has made patterns less useful. But you cannot over interpret this test: ANA positivity, regardless of pattern, is not helpful without knowing your symptoms. Everything boils down to symptoms;; rheum md would be very helpful.
A 39-year-old female asked:
Dr. Alfred Kim
Rheumatology 16 years experience
Again, symptoms key: Here, positive labs tests are not clinically important without symptoms. Your ESR would be consistent with age; i would ignore that along with the ANA if there are no symptoms consistent with lupus. See your md.
A 28-year-old male asked:
Dr. Alfred Kim
Rheumatology 16 years experience
Dermal skin injury: Discoid lupus (think singer seal) is seen by itself or with systemic lupus erythematosus (sle). Abut 25% of sle pts have discoid symptoms. If discoid lupus is by itself, 5-10% of them will go on to have sle, but the disease is relatively mild. Discoid lesions are areas of inflammation that go through the dermal layer of skin, causing scarring (like stretch marks). Sometimes mistaken for psoriasis.
A 39-year-old female asked:
Dr. Alfred Kim
Rheumatology 16 years experience
Depends on symptoms: ANA is a screen for lupus. The titer can be helpful in borderline lupus cases, but you must have symptoms c/w lupus. Dsdna, ENA panel needs to be ordered. The high esr: again, depends on how high it is. For females, normal is usually (age+10)/2, so for you, around the mid-20's. Some labs say >20 is high; i disagree. Everything for you boils down to symptoms though; rheum md would be very helpful.
A 21-year-old member asked:
Dr. Alfred Kim
Rheumatology 16 years experience
IL-6: Would look toward john stone's work at mgh (harvard) trying to determine which fraction of giant cell arteritis (which is seen in 50% of pmr cases and thought to be related) is due to elevated il-6 or hyperactive il-6 receptor signaling.
4 thanks
A 28-year-old female asked:
Dr. Alfred Kim
Rheumatology 16 years experience
PMR likely autoimm: So ANA is probably the most misinterpreted test by almost everyone: it is just a screen for autoimmunity, but not all autoimmunity. And a positive ANA does not mean disease. So, pmr is ANA negative, but still may represent an autoimmune condition. What the autoimmune target is remains unclear though. True, it is exclusively seen in older (>50-60 yo) people, and this remains unclear why also.
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A 28-year-old female asked:
Dr. Alfred Kim
Rheumatology 16 years experience
IL-6: Pmr & a related disease giant cell arteritis seem to share 1 quality: higher levels of a cytokine (immune protein) called interleukin-6. Why this is remains unclear, but il-6 drives the production of acute phase reactants which increase esr. Other autoimmune diseases appear to rely less on il-6 and more on other cytokines (tnf-a in ra) for inflammation.
3 thanks
A 28-year-old male asked:
Dr. Alfred Kim
Rheumatology 16 years experience
Vasculitis: Takayasu arteritis is a inflammatory condition of the large arterial vessels emerging from your heart (the aorta and branching vessels). It is unknown what the etiology is, although it is pretty clear the immune system drives this process (especially il-6). Main initial symptoms are vague (fatigue, low-grade fever) but as it progresses, the lightheadedness and a cold arm from reduced blood flow.
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A 27-year-old female asked:
Dr. Alfred Kim
Rheumatology 16 years experience
Don't overintepret: 1st ?: lupus is a diagnosis based on symptoms, not labs. Someone can have (+) ana, (-) dsdna, and symptoms that can be best explained by lupus, so they have lupus. Alternatively, someone else can have (+) ANA & dsdna, but no symptoms. They do not have lupus. 2nd ?: just because something is high means it's abnormal. A unproven but latest hypothesis: dsdna ab might be a result of normal immunity.
A 28-year-old female asked:
Dr. Alfred Kim
Rheumatology 16 years experience
Not necessarily: You are lucky not to have internal organ involvement (for those in the us, nba legend kevin mchale lost his 22 yo daughter today from lupus), but Methotrexate does not significantly increase health risk as long as you maintain good followup with your rheumatologist. I would further argue that Methotrexate is a small price to pay to ensure that your lupus does not worsen.
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