Autoimmune Disorders: Symptoms, Diagnosis, and Treatment

Q: Autoimmune Disorders: Symptoms, Diagnosis, and Treatment

Hello, thank you for your questions. <br>Here are my responses：<br>1. <br>Should taking quinine prevent fever? I informed you that I had a fever for a while that day! But if I haven't been examined, which department should I consult to find out where the inflammation is? --> Feve

Immune system diseases

Hello Doctor,
I apologize for the lengthy message.
This past March, I experienced a persistent low-grade fever for a month and had blood tests done, which indicated elevated immune system markers suggesting rheumatoid arthritis.
I was then referred to a rheumatologist.
The doctor assessed my hand strength and observed my walking.
He concluded that I did not present as a typical rheumatoid arthritis patient but diagnosed me with Raynaud's phenomenon.

Subsequently, I noticed that the purple blood vessels in my palms, which were previously invisible, became clearly visible, and my skin became very wrinkled.
My extremities experience sharp pain when exposed to cold, and they become red, swollen, and painful when warm.
I also developed skin sensitivity, where even light contact with fabrics feels painful, and water exposure is also painful.
I began to experience numbness and was referred to another immunologist, who suggested that I might be more aligned with systemic lupus erythematosus (SLE).
However, the symptoms I found online seem quite similar, and I do not have a butterfly rash.
I have been diligent with sun protection, yet my extremities still feel very hot, painful, and itchy.

I have been consistently taking medication (quinine twice a day and anticoagulants).
In August, I suddenly had another episode of persistent low-grade fever.
During my follow-up on August 24, the doctor noted that I was still experiencing fever despite taking quinine.
However, we need to identify the cause of the low-grade fever.
I was scheduled for blood tests on September 14, but I continued to have fever into September.
Generally, I only feel fatigued and have headaches, with no other discomfort, so I am unsure how to identify the cause.

On September 21, I was prescribed corticosteroids, and I had blood tests on September 24, with results expected on September 27.

I have several questions:
1.
Shouldn't taking quinine prevent fever? I informed the doctor that I had been experiencing fever for some time, but if no tests were conducted, which specialty should I consult to determine the source of inflammation?
2.
At the end of each follow-up, the last comment is always, "We'll continue to monitor!" However, the medication remains unchanged, and no blood tests are performed.
How often should I have blood tests, or should it depend on the symptoms I am experiencing?
3.
After my blood test on September 14, I asked the doctor about my current condition, but he did not clarify whether I might not have systemic lupus erythematosus.
If I am prescribed corticosteroids, does that indicate a negative implication?
4.
My skin feels hot all day, and now my face has started to feel warm and red (previously, it was only my extremities).
What should I do?
5.
My skin itches at night, and I hesitate to scratch.
Can I first consult a dermatologist?
6.
I have heard that confirming a diagnosis can take a long time.
If I suddenly feel discomfort elsewhere, should I return for an earlier appointment, or should I see a specialist based on where the pain is?
I kindly ask for your guidance.
Thank you!

Gui Nu, 30~39 year old female. Ask Date: 2022/09/23

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your questions.
Here are my responses:
1.
Should taking quinine prevent fever? I informed you that I had a fever for a while that day! But if I haven't been examined, which department should I consult to find out where the inflammation is? --> Fever is one of the reasons we prescribe quinine, but quinine is not effective for all inflammatory fevers.
The optimal time for quinine to take effect is often around three months; if the results are not satisfactory during this period, we may indeed add corticosteroids or anti-inflammatory pain relievers to help control the fever.
Currently, I recommend that you continue to follow up with the Allergy, Immunology, and Rheumatology department.
2.
At the end of each follow-up appointment, the last thing I hear is "We'll continue to monitor!" but the medication hasn't changed and no blood tests were done? How often should I have blood tests, or should it depend on the symptoms I experience? --> Generally, we would follow up every three months.
If new symptoms arise, we may conduct blood tests earlier.
This can be discussed with your physician.
3.
After my blood test on 9/14, I asked the doctor, but he didn't inform me of my current condition.
Is it possible that I do not have lupus erythematosus!? But I have been prescribed corticosteroids? Does that indicate something negative? --> I think you can list your questions and ask your physician one by one.
In principle, we should provide you with a preliminary diagnosis.
The reason for adding corticosteroids, as mentioned in question one, is to help alleviate symptoms before quinine takes full effect; it does not necessarily mean that your condition is worsening.
4.
My skin feels hot all day, and my face has started to turn red too! (Previously, it was only my limbs.) What should I do? --> It is advisable to rely on the temperature recorded by a thermometer; feeling feverish does not always indicate an actual fever.
If the thermometer indeed records a fever and you continue to have a fever despite current treatment, you can return to consult your attending physician sooner.
5.
My skin itches at night, and I don't dare to scratch! Can I go to a dermatologist for consultation? --> Yes, you can.
Quinine may cause itching, and you can provide this information to your dermatologist.
6.
I heard it takes a long time to confirm the diagnosis!? If I suddenly feel unwell elsewhere, should I return for an earlier appointment, or should I see the relevant department based on where it hurts? --> Some rheumatic diseases cannot be diagnosed immediately or within three months.
In such cases, we will initially label it as "undetermined rheumatic disease." After a period of monitoring, some rheumatic diseases may present more clearly, allowing for a more definitive diagnosis.
During this time, you can continue to report symptoms to your attending physician for evaluation; of course, if new symptoms arise or if you feel significantly worse, you can return for an earlier appointment.
During this period, I recommend continuing to follow up with the Allergy, Immunology, and Rheumatology department.
Changhua Hospital, Ministry of Health and Welfare, Allergy, Immunology, and Rheumatology Department cares about you.

Reply Date: 2022/09/23

More Info

Understanding autoimmune disorders can be quite complex, especially when symptoms overlap between different conditions. Based on your description, it seems you are experiencing a range of symptoms that could be indicative of various autoimmune diseases, including rheumatoid arthritis, lupus, and possibly others. Here’s a comprehensive overview of autoimmune disorders, their symptoms, diagnosis, and treatment options.

Symptoms of Autoimmune Disorders
Autoimmune disorders occur when the immune system mistakenly attacks the body’s own tissues. Common symptoms include:
- Fatigue: Persistent tiredness that doesn’t improve with rest.

- Fever: Low-grade fevers can be common, especially during flare-ups.

- Joint Pain and Swelling: This is particularly characteristic of rheumatoid arthritis.

- Skin Changes: Rashes, redness, or sensitivity to touch, as you described, can occur in conditions like lupus.

- Raynaud’s Phenomenon: This condition causes fingers and toes to turn white or blue in response to cold or stress, which you mentioned experiencing.

- Neurological Symptoms: Tingling, numbness, or pain in the extremities can occur, indicating nerve involvement.

Diagnosis
Diagnosing autoimmune disorders often involves a combination of clinical evaluation and laboratory tests. Here are some steps typically involved:
1. Clinical Evaluation: A thorough history and physical examination by a rheumatologist or immunologist is crucial. They will assess your symptoms, family history, and any physical signs of autoimmune disease.

2. Blood Tests: Tests for specific autoantibodies (like ANA, anti-dsDNA for lupus, or rheumatoid factor for rheumatoid arthritis) can help confirm a diagnosis. Elevated inflammatory markers (like ESR or CRP) may also be indicative.

3. Imaging Studies: X-rays or MRIs may be used to assess joint damage or inflammation.

4. Skin Biopsy: If skin symptoms are prominent, a biopsy can help determine the cause.

Treatment Options
Treatment for autoimmune disorders is often tailored to the individual and may include:
- Medications:
- Corticosteroids: These can help reduce inflammation and suppress the immune response. However, long-term use can have side effects, so they are usually prescribed at the lowest effective dose.

- Disease-Modifying Antirheumatic Drugs (DMARDs): Medications like methotrexate can help control symptoms and prevent disease progression.

- Biologics: Targeted therapies that can be effective for certain autoimmune diseases.

- Lifestyle Modifications:
- Diet: A balanced diet rich in anti-inflammatory foods (like omega-3 fatty acids) can help manage symptoms. Avoiding triggers (like processed foods or allergens) may also be beneficial.

- Exercise: Regular, low-impact exercise can help maintain joint function and reduce fatigue.

- Symptom Management:
- Pain Relief: Over-the-counter pain relievers can help manage discomfort.

- Skin Care: For skin symptoms, gentle moisturizers and avoiding irritants can help.

Monitoring and Follow-Up
Regular follow-up with your healthcare provider is essential. Here are some considerations:
1. Frequency of Blood Tests: The frequency of blood tests can depend on your symptoms and treatment. If you are stable, tests may be done every few months, but if symptoms worsen, more frequent testing may be necessary.

2. Symptom Tracking: Keep a diary of your symptoms, including when they occur and their severity. This can help your doctor make informed decisions about your treatment.

3. Specialist Referrals: If skin symptoms are severe, a referral to a dermatologist may be warranted. For neurological symptoms, a neurologist may be involved.

4. Emergency Symptoms: If you experience sudden changes in your condition, such as severe pain, difficulty breathing, or neurological changes, seek medical attention promptly.

Conclusion
Autoimmune disorders can be challenging to diagnose and manage due to their complex nature and overlapping symptoms. It’s crucial to work closely with your healthcare team to monitor your condition and adjust treatment as necessary. Don’t hesitate to seek second opinions or consult specialists if you feel your concerns are not being adequately addressed. Your health and comfort are paramount, and proactive management can significantly improve your quality of life.

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