Q: My wife has been diagnosed with lupus, celiac disease, rheumatoid arthritis, fibromyalgia, and has a host of issues that accompany these problems. She started out with lupus and has added a new disease every few years since the original diagnosis. She now has uncontrolled bowel leakage with no evidence of celiac flareup. She has been on Celebrex for years. Since all of the disorders are immune-related, is there one person that can treat all conditions and look more at the overall approach instead of one disease at a time?
A: The immune system works to defend a body against germs or antigens. Examples of antigens include bacteria, toxins, viruses, and cancer cells. When the body recognizes an antigen, it produces antibodies that work to destroy those harmful substances. Immune disorders are a malfunctions of a system that can be characterized in several ways, such as whether the conditions is congenital or acquired and whether the immune system is under-or-over active. According to the International Union of Immunological Societies, more than 150 primary immunodeficiency diseases have been characterized and it is believed most people have at least one primary immunodeficiency (PID) that may include rheumatoid arthritis, type I diabetes, pernicious anemia, lupus, vasculitis and Goodpasture’s syndrome. PIDs are those caused by inherited genetic mutations, whereas secondary or acquired immune deficiencies may be caused by such things as a virus or immune suppressing drugs. Secondary disorders are more common than are primary. If an individual has an immunodeficiency disorder, his or her body does not have the ability to fight infections or diseases as it should. The immune system is the body’s defense against germs. Without it, bacteria and viruses would escalate out of control. Common autoimmune diseases include lupus, rheumatoid arthritis and type I diabetes. It should be noted that sometimes the body incorrectly reads normal tissue as foreign which causes joint and organ inflammation when there is no foreign material that it should be fighting.
Signs to help a physician make a diagnosis include infections that repeat, those that are uncommonly severe and ordinarily should not be, delayed recovery from a specific illness, having a poor response to treatment provided, and more. Testing to help with making a diagnosis may be accomplished through blood drawing that may include a white blood cell count, protein electrophoresis, a T lymphocyte count, ANA, rheumatoid factor, urinalysis and more.
The Celebrex your wife is on is in a class of drugs referred to as non-steroidal anti-inflammatory drugs (NSAIDS) that work toward reducing inflammation and pain. Common side effects include cough, fever and inflammation of the extremities. Less common side effects include anxiety, constipation, and paridoxically difficulties with movement, joint pain, muscle stiffness, and a great deal more. While it is possible her physician can provide this or other medications to decrease her unwanted symptoms, I feel she should be under the care of a top-notch immunologist who deals with physiological functioning of the immune system in health and disease, as well as with malfunctions of the immune system disorders. Speak with your wife’s primary care physician regarding a referral to someone in your area or telephone your local hospital to determine if they have an rheumatologist on staff who may wish to partner with a gastroenterologist for the celiac disease. It’s time your wife receives some relief and it sounds as if you are on the right track to help her get it. Good luck.
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