Sjorgens Syndrome

[Dado5]

You're making it tough on me, lol.

There's several missing thyroid antibodies tests.

While we're at it, may as well rule out Myasthenia gravis. Dado5, if I'm not mistaken didn't you a few years ago have some hypercoagulopathy and breathing issues?

Hey Stewie. That wasn't me.

 

[Stewie]

Hey Stewie. That wasn't me.

For some reason I thought you had repeated INR testing done?

Must have been somebody else I was thinking about then?

 

[Pissbrainiac259]

You're making it tough on me, lol.

There's several missing thyroid antibodies tests.

While we're at it, may as well rule out Myasthenia gravis. Dado5, if I'm not mistaken didn't you a few years ago have some hypercoagulopathy and breathing issues?

Two ways to test for MG and of the two ways, the most specific one is a Tensilon test. Give them an IM shot of Edrophonium which is a very short acting Acetylcholine Esterase inhibitor. The half-life ranges from 10-100 mins so you might want to keep your patient from walking around unless you want to punt them to Neuro s/p head trauma. The other possibility is your patient develops a cholinergic crisis. Uh-oh spaghetti-oh. Better think fast!

 

[Dado5]

For some reason I thought you had repeated INR testing done?

Must have been somebody else I was thinking about then?

oh yes , that was me. that was about 6 y ago. everything was fine

 

[Pissbrainiac259]

Dont know, thats what he ordered..

Anything specific to test ?

Can you easily consume a pack of saltine crackers without drinking any water?

 

[Pissbrainiac259]

For some reason I thought you had repeated INR testing done?

Must have been somebody else I was thinking about then?

Ooooooh....coagulopathies are markedly interesting. Some nerd can still draw the entire coagulation cascade complete with protein clotting factors and cofactors. What a fkn nerd.

 

[Pissbrainiac259]

You're making it tough on me, lol.

There's several missing thyroid antibodies tests.

While we're at it, may as well rule out Myasthenia gravis. Dado5, if I'm not mistaken didn't you a few years ago have some hypercoagulopathy and breathing issues?

Challenging but not impossible. Have you considered anti-SS-A antibodies (anti-Ro) and anti-SS-B antibodies (anti-La)? :lightbulb:

 

[Dado5]

Got rest of the tets results... all came normal/negative

anti-SS-A antibodies (anti-Ro) ,anti-SS-B antibodies (anti-La)
anti-dsDNA, anti-RNP
anti-Smith (or anti-Sm)
anti-Jo-1
anti-CCP

My a1c is 5.9 so i need to watch my diet

 

[Dado5]

What I am wondering is this:

I got a puppy 4 months ago, she was 7 weeks when I got her. While teething she was biting my hands like crazy. From her puppy teeth I was having lots of wounds and scratches on my hands .
I am wondering if something from puppy bites has triggered some reaction in my body to go out of wack and cause ANA positive and feelings I had..

 

[MyNameIsJeff]

Would suggest testing for Anti-centromere antibodies (ACAs). Otherwise it's time for a salivary gland biopsy.

 

[Pissbrainiac259]

Would suggest testing for Anti-centromere antibodies (ACAs). Otherwise it's time for a salivary gland biopsy.

Not a bad thought but he given his signs/sx's, it would be very low on the DDx. That being said, anti-Centromere Abs is highly specific for CREST syndrome which stands for:

anti-Centromere abs (or Calcinosis)
Raynaud's phenomenon
Esophageal dysmotility
Scerlodactyly
Telangiectasia

A lip +/- salivary gland bx to confirm a dx of Sjogren's which is a good idea since anti-SS-A Abs is + in ~55% of cases while anti-SS-B Abs is + in ~30% of cases, the bx should show demonstrate lymphoplasmacytic infiltration. However, don't be disappointed b/c 40-60% of ALL bx's come back "inconclusive" or "indeterminate". One final bit of minutiae, Sjogren's syndrome (I hate medical eponyms), can be a primary disorder or a secondary disorder associated w/ RA, Hypothyroidism, SLE, Scleroderma, Polymyositis, HIV, and several other less common conditions.

 

[Pissbrainiac259]

What I am wondering is this:

I got a puppy 4 months ago, she was 7 weeks when I got her. While teething she was biting my hands like crazy. From her puppy teeth I was having lots of wounds and scratches on my hands .
I am wondering if something from puppy bites has triggered some reaction in my body to go out of wack and cause ANA positive and feelings I had..

If that were the case, then a CBC w/diff would demonstrate eosinophilia (high levels of eosinophils). Also watch out for Cat Scratch Fever aka Bartonella henselae caused by the bacteria Borrelia recurrentis.

 

[Pissbrainiac259]

Got rest of the tets results... all came normal/negative

anti-SS-A antibodies (anti-Ro) ,anti-SS-B antibodies (anti-La)
anti-dsDNA, anti-RNP
anti-Smith (or anti-Sm)
anti-Jo-1
anti-CCP

My a1c is 5.9 so i need to watch my diet

A HbA1c of 5.9 is fkn awesome. Highest I've ever seen is 18.something. Dude, still lived. SMH

 

[Pissbrainiac259]

We just call it "anti-CCP Abs" and the brilliant guy who developed that specific Rheumatological test was one of my professors back in the day.

"The Red Book" aka The 'bible' for Rheumatology.

 

[nickels]

Interesting, ive had many of those symptoms and have never been able to find the root cause. Ill look into it as well.

Same.



One of my doctors suggested Sjogrens, but I didn't do further tests.

 

[Stewie]

"The Red Book" aka The 'bible' for Rheumatology.

When I get bored, I'll thumb through these two. Oldies but goodies.

 

[Pissbrainiac259]

When I get bored, I'll thumb through these two. Oldies but goodies.

Where on Earth did you get these "medical books"?

 

[Stewie]

Where on Earth did you get these "medical books"?

A very close friend of mine that's a retired hematologist-oncologist. He had quite the library of med books.

I've given away close to a dozen medical textbooks he's giving me.