Other Rheum Conditions

Get to know the anti-centromere antibody

September 14, 2021 ·

The anti-centromere antibody rarely comes up in casual conversation. Even doctors are easily confounded by this antibody. Doctors can give confusing or mixed messages regarding a centromere antibody result and this can send even the most levelheaded into a tailspin.

What is a centromere?

We might need to return to high school biology to answer this. Stick with me as we do a quick refresher. The centromere is a piece of DNA that attaches to chromatids to form a chromosome. (!!!) We all have 46 chromosomes or 23 pairs. (Think of “23 and me”) The chromosome is a structure that houses all our DNA. We find this structure in the nucleus of our cells, making, by definition, the centromere antibody an anti-nuclear antibody, or ANA. The anti-centromere antibody, thus, can be positive in those with a positive ANA result. Remember, the ANA blood test is a general, non-specific anti-nuclear antibody blood test while the anti-centromere antibody test is a more specific type of ANA. This then would make a positive centromere antibody result with a negative ANA, very unlikely.

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Sjogren’s Syndrome: know the facts

September 7, 2021 ·

You’ve been waiting for this appointment for months. Your mind races as you wait for your name to be called. This all started when you made an appointment with your doctor on your dentist’s recommendations. You had more cavities than usual and your dentist recommended you get checked for an autoimmune condition. An autoimmune condition? Really? Sure, you have been tired the last few months, but life is busy and who isn’t tired these days? Your doctor did some tests and said you have rheumatoid arthritis. WHAT? You are given a copy of your labs, the name of rheumatologist and told to take Advil.

The four-month wait for the rheumatology appointment gives you plenty of time to investigate your labs, and to your dismay, you find you are ANA positive. Dr. Google immediately informs you that you likely have lupus. Let the spiraling commence. Why didn’t my doctor mention this? How could this happen? Am I going to die?

They call your name and usher you back. Blood pressure is a little elevated – not surprising given what you are bracing yourself to hear. Waiting again. Finally, the doctor arrives. She looks over your labs, does a physical, and says “You don’t have lupus or RA.” A wave of relief washes over you. Your future suddenly becomes clear again. “But you have Sjogren’s Syndrome.”

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Raynaud’s Syndrome

June 23, 2021 ·

(Pause while everyone looks down at their own nails)

I learned to include this little pause during my medical student lectures on Raynaud’s Syndrome and Scleroderma. As opposed to many of the other conditions I treat and teach, there is actually a very high likelihood that a handful in the audience will have Raynaud’s. This isn’t surprising given how common it is, especially amongst women between the ages of 15 and 30. It is when discussing the connection between Raynaud’s and Lupus or Scleroderma, that the wave of concern washes over some faces in the audience. What the audience members are looking for are changes in the nail bed capillaries. These changes, can be a sign that their Raynaud’s Syndrome is part of a larger autoimmune condition. Thankfully, most, if not all, will have perfectly normal nail bed capillaries and be able to sit through the rest of the lecture panic-free. But it is always a reminder that even when speaking to trainees and students, I am speaking to patients.

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What is Scleroderma?

June 8, 2021 ·

“Please don’t google this until we have more information.”

That’s not something I often say to my patients. I usually write out diagnoses and treatments, specifically so patients CAN google and research them. The internet is a wild place but I still stand on the side of more information is better than less. Yet, when it comes to scleroderma, I take a different approach. I want to make sure my patients have 1) the right diagnosis and 2) an appropriate perspective on their diagnosis before engaging with, what can be, the scary world of scleroderma online. Because I also know that a scleroderma diagnosis doesn’t have to be that scary.

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Transitioning from the pediatrician’s office

June 1, 2021 ·

Being diagnosed with a chronic medical condition during childhood or adolescence shapes the lives of the patient and their family. In Rheumatology, the pediatric rheumatologist can become an additional parent and a partner. Pediatric hospitals and clinics become homes away from home. They are often painted bright colors, have comfy furniture and entertainment throughout the halls as everyone tries to make the heartbreaking reality of disease in children more palatable. Thankfully, treatment success in rheumatology is the norm and there will come a day in most patient’s lives when they need to say goodbye to their pediatric rheumatologist and find a new adult-focused rheumatologist. Transitioning from the pediatrician’s office is a day most patients and parents dread. This process, known as “transition,” is an integral part to any young person’s care.

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