a R's Update/SLE and RA Coexistence

[Guest guest]

a R,

It IS possible to have SLE and RA concurrently, but it is EXTREMELY

uncommon. Please read what rheumatologist Dr. Wallace, one of the

country's leading clinicians and researchers of lupus, has to say about it:

" Do SLE and RA co-exist? It has long been known that patients may start with

a diagnosis of RA or SLE that becomes SLE or RA over a period of years.

Assuming that MCTD is not present, however, the true co-existence of these

conditions is rare. Despite the frequent clinical overlap between RA and SLE

features, the combination of advanced, deforming, erosive RA and a

significant degree of biopsy-proven SLE is an extremely unusual finding.

Occasional case reports have appeared documenting a true co-existence. Of my

own group's 464 (four hundred sixty-four) patients with idiopathic SLE, 1

(one) had classic seropositive, erosive, nodular RA with biopsy-documented

proliferative SLE nephritis and nephrotic syndrome. The concurrence of

subacute cutaneous LE in patients with RA who are Ro/SSA-positive is more

common. Cohen and Webb reported the development of SLE in 11 Australian

patients with typical RA who were observed over a 17-year period, but the

total number of patients with RA followed was not stated. Brand et al.

presented 11 co-existing cases; most had class II genetic determinations of

both disorders. Panush et al. have identified a true co-existence in 6 (six)

of 7000 (seven thousand) patients with RA who were evaluated over an 11-year

period. It was concluded that " rhupus " did not occur more frequently (0.09%)

than expected from the chance concurrence of SLE and RA (1.2%). "

The above information came from Drs. Wallace and Hahn's lupus book for

physicians entitled, " DuBois' Lupus Erythematosus " (1997, and

Wilkins, 5th edition). This book is considered by many to be the lupus bible

for physicians.

The study that Panush's group did is the largest number of patients in a

study like this I have found so far; out of 7000 RA patients followed for

over ten years, only six were found to have both RA and SLE. That is

dramatic. So, what I am saying is that far more people in our group (or who

have come through our group and are no longer here) have been told that they

have both SLE and RA (or could have them both) than is statistically likely.

I'm not saying that it is impossible that you could indeed be one of those

rare people sometime in the future (or that it is impossible for anyone else

here to be), I just trying to help you understand that it is quite unlikely.

I would guess that, conservatively, I have heard approximately twenty people

in our forum say that they have both SLE and RA or that their physician is

considering giving them both diagnoses (and we don't have thousands of

people coming through and announcing their actual or possible diagnoses).

If SLE and RA are being considered in a differential diagnosis for a given

patient, it's overwhelmingly likely that it is an either/or situation (not

both), or it is an overlap condition like MCTD or UCTD.

So what's the big deal? Does it really matter what the diagnosis is? Well,

it does in regards to treatment and monitoring of your disease. SLE and RA

are very different diseases. Without the correct diagnosis, you can't be

assured that you are receiving appropriate medication and monitoring for

your disease.

Yes, carpal tunnel syndrome (CTS) is thought to have an association with RA.

Sorry your hand is giving you so much trouble.

----- Original Message -----

From: " a R " <mquiltn@...>

< >

Sent: Wednesday, March 28, 2001 6:15 PM

Subject: [ ] Re: a R's Update

> ,

> I think what my doctor meant was that he couldnt verify that i had

> lupus based on the ANA test since I dont show the other signs. I

> asked him if it was posible to have lupus and RA at the same time and

> he same definately yes. He didnt say how common it was though. as for

> the sjorgrens, he just said i did have it, but i dont have any of the

> symptoms either.

>

> I have another question. Is carpal Tunnel related to RA? I had a bout

> with CT prior to my diagnosis of RA but after the symptoms began. I

> am having difficulty lately with alot of pain in my right hand( i

> seem to have RA more in my left than my right hand) and wondered it

> it could be RA or CT. the pain in in my wrist and i have difficulty

> straigtening out my hand.

>

> aR

>

>

>

> > Hello, a R.!

> >

> > Sorry that you are hurting. You don't sound like a wimp to me. I

> hope that

> > you are feeling much better very soon.

> >

> > I can't answer your questions about MTX from personal experience,

> but I'm

> > hoping that some of our other members will. Since the MTX will most

> likely

> > take a few weeks or more before you notice any effects, did the

> doctor

> > recommend taking something with it in the meanwhile?

> >

> > Just a gentle reminder that it's misleading for anyone, especially a

> > physician, to refer to the ANA test as the " lupus test " or to say

> that when

> > a patient has a positive ANA that the patient has tested positive

> for lupus.

> > This is not true. ANA can be positive for a great number of reasons

> (and can

> > even be positive in healthy individuals) - it is not specific to

> lupus

> > (sensitive, yes; specific, no). Some estimates are that only up to

> 10% of

> > all individuals who test positive for the ANA in the US will ever

> be diagnosed with lupus.

> >

> > Also, in the absence of an overlap syndrome, the true concurrence

> of SLE and

> > RA is rare. So, for the physician to diagnose you with RA now and

> say that

> > maybe lupus will be added later is a strange approach. It may be

> better to

> > say that your diagnosis is uncertain or that, for now, it is RA,

> but it

> > could be changed to SLE later. Or is that what your physician was

> saying?

> >

> > In addition, as far as I know, there is no blood test yet that can

> rule out

> > (or rule in) Sjogren's Syndrome (much like RF or any other blood

> test

> > cannot either make or break an RA diagnosis alone). In fact, the

> > classification criteria for Sjogren's Syndrome are still being

> disputed

> > throughout the world. According to what I read in " The New Sjogren's

> > Syndrome Handbook " (1998, Oxford University Press), there are

> currently six

> > different groups who have distinct yet generally similar criteria

> sets that

> > have been proposed as a universal standard; there is no consensus

> yet.

> >

> > If your physician ordered the anti-Ro/SS-A and/or the anti-La/SS-B

> antibody

> > tests, just be aware that those tests are not highly specific or

> sensitive

> > to Sjogren's Syndrome.

> >

> > If anything, the minor salivary gland biopsy that can be done to

> aid in a

> > diagnosis of Sjogren's Syndrome would probably be the test most

> specific to

> > the disease.

> >

> > Here is an excellent article in Medscape about Sjogren's Syndrome:

> >

> >

> http://www.medscape.com/medscape/Rheumatology/TreatmentUpdate/2000/tu0

> 1/public/toc-tu01.html

> >

> > Here is a link to the Sjogren's Syndrome Foundation:

> >

> > http://www.sjogrens.com/index.html

> >

> >

> > I hope what I've said here makes sense. You might have a few

> questions to

> > ask your doctor next time.

> >

> > Good luck with the methotrexate!

> >

> >