Erin--positive rf and tb?

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elcamino
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Date Joined Sep 2005
Total Posts : 1744
   Posted 3/6/2007 10:26 AM (GMT -7)   
Erin, I was reading your post on RF 101, and you mentioned that rf was implicated in tb.  How common is that?  I ask because I've always been low positive on rf, rheumy dx me with RA but said I didn't have RA (allows him to treat me with the drugs), but I'm ana negative, so SLE is out of the question as well.  Now that I may actually have tb, I'm wondering if that is what is causing the positive rf?  You worked on a tb ward, right?  Can tb cause arthritis?  I respond very well to prednisone, methotrexate, and enbrel (arthritis-wise).  Do I have a rheumatoid disease or do I simply have tb?
 
I'm so confused now :)
 
Elcamino
Current dx: Rheumatoid Arthritis
Suspected dx: UCTD/Early Lupus
Current Meds: Enbrel, Plaquenil, Aciphex, Ultracet, Zyrtec, Allavert-D, Zantac, Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan


erin.K
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Date Joined Mar 2005
Total Posts : 3148
   Posted 3/6/2007 1:25 PM (GMT -7)   
hey El,
 
the RF is one of those things that confuses Dr.s & pts alike.  it's just an antibody saying "somethin's going on immune-wise".
 
it can show up in all of those conditions because it can be a false positive.
 
in the instance of a TB case being mistaken for RA?  it would happen kinda like this:
 
(well you already know that TB is a type of pneumonia caused by Mycobacterium tuberculosis...and any bacteria in the body, left untreated for longer than it should...will result in an arthritis)
here's a rare scenario:  extrapulmonary TB happens to a person when the TB bacilli is SWALLOWED! goes through the GI tract, (small intestines), GU tract, skin, liver, Joints, bones.  however, this is usually seen in HIV pt.s (but...us being on massive immunosuppressants puts us in the same category: open to oportunistic infections like HIV/AIDS pts.)
 
joint pain, fatigue, weight loss, pleurisy, pleuritis, fevers, low grade fevers, enlarged lymph nodes...these go for RA and TB...and a hundred other illnesses.  so everybody's confused until meds start & you see if you respond to them.
 
also, we can't forget a Reactive Arthritis from an infection too...oh yeah keep on adding to the fun.  i mean, sure...being treated for RA (or any inflammatory arthritis) WOULD NOT HAVE BEEN A BAD MOVE.  you respond well to some meds for infl. arth. so that's a good thing. who knows...it could be both a case of RA and a reactivated TB!  it's possible.
 
i forget...but was there ever an early morning sputum culture taken?
 
i'm just throwing you some cases that i have worked on. and pretty much everything i know...(i think i'm tapped dry now! lol).
 
don't be surprised if the joints improve further once AX treatment starts too!
 
if i think of anything else i'll let ya know.
 
((((((((((hugs)))))))))))))


Arthritis Forum Moderator
Active Severe Rheumatory Arthritis. Crohns Disease. A.Chiari Malformation & right brain venous anomoly. Partial Complex Seizures (under control!). MVP & Tricuspid Valve Prolapse. Rheumatic heart & lung. Previous Lymes Disease for 10 years.
Meds: Remicade infusions 300mg Q3weeks; Intra-articular knee injections when needed; Mercaptopurine 50mgQD plus 75mg weekly; Mesalamine 4GramsQD; Prednisone 10mgQD mantainance; Entocort 9mgQD; Meclizine; Augmentin; Tigan 300mg; Reglan; LidoDerm Patches; Diazepam 5mg for AS back spasms; Rozerem 8mg; Dilaudid 4mg tabs for pain. 


elcamino
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Date Joined Sep 2005
Total Posts : 1744
   Posted 3/6/2007 5:01 PM (GMT -7)   
Erin--how fortunate that you used to work on a tb ward! You know so much! I did have a sputnum culture done last week. It was mailed off on Friday. I'm still waiting on the results (takes two days), but since I haven't heard yet I'm kind of assuming that it's negative. TB nurse assured me if it was positive I would get an early phone call. Both my doctor and the tb nurse expected that it would be negative simply because I've been on immunosuppressants for 1. 5 years now. I think doctor just ordered it because it's a necessary step to take in any tb case. In any case, doctor told me to make sure to do the culture before I started the tx. I started the tx this morning. Was nauseous and extremely tired all day. But then I'm also coming down off the enbrel--that may be where the fatigue is coming from. I'm going to watch American Idol and go to bed!

Thanks so much for sharing your knowledge--it gives me lots to talk about with my rheumy when I see him next week.

El
Current dx: Rheumatoid Arthritis
Suspected dx: UCTD/Early Lupus
Current Meds: Enbrel, Plaquenil, Aciphex, Ultracet, Zyrtec, Allavert-D, Zantac, Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan


erin.K
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Date Joined Mar 2005
Total Posts : 3148
   Posted 3/6/2007 7:04 PM (GMT -7)   
Hah!...That's too funny you called it a TB ward...(they just stick em' on a regular MEDSURG unit, lol) of course withthe pressurized rooms and all.
I have always kept all of my clinical notes/research and everything when I had interesting patients...they're good to look back on.
Oh yeah...shoot, print it out & show it to em'. Pick her/his brain about the TB joint thing & see what the rheummy thinks.
I guess all of those times where I asked to be given the ID pts and all the MRSA & VRSA and (I love all those good bugs) actually pays off!
Wow...you'll be getting your results fast! Unless it was just the hospital I was in that took a way long time to culture.
If I remember any tips or tricks with dealing with the nausea I will let you know right away.

{{{{{{{{{{{ BIG HUGS }}}}}}}}}}}}}
Arthritis Forum Moderator
Active Severe Rheumatory Arthritis. Crohns Disease. A.Chiari Malformation & right brain venous anomoly. Partial Complex Seizures (under control!). MVP & Tricuspid Valve Prolapse. Rheumatic heart & lung. Previous Lymes Disease for 10 years.
Meds: Remicade infusions 300mg Q3weeks; Intra-articular knee injections when needed; Mercaptopurine 50mgQD plus 75mg weekly; Mesalamine 4GramsQD; Prednisone 10mgQD mantainance; Entocort 9mgQD; Meclizine; Augmentin; Tigan 300mg; Reglan; LidoDerm Patches; Diazepam 5mg for AS back spasms; Rozerem 8mg; Dilaudid 4mg tabs for pain. 


elcamino
Veteran Member


Date Joined Sep 2005
Total Posts : 1744
   Posted 3/7/2007 5:50 AM (GMT -7)   

Erin, let me clarify. I will be getting the initial reading back today or so.  Doctor told me it can take up to 8 weeks for tb to be properly cultured.  Personally, I don't expect they will find any tb.  I have no sx other than a low-grade fever and some congestion (very little coughing, though).

This morning after I took the meds, I ate some pretzels.  I know you're not supposed to eat when you take the meds, but from what I've read that's not supported anywhere.  So far, I don't feel nauseous, but jeez was I ever nauseous last night!

Elcamino


Current dx: Rheumatoid Arthritis
Suspected dx: UCTD/Early Lupus
Current Meds: Enbrel, Plaquenil, Aciphex, Ultracet, Zyrtec, Allavert-D, Zantac, Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan


erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 3/7/2007 8:32 PM (GMT -7)   
oh good, cuz i was thinking, "how could they culture them sooo fast!"  i've always known them to take weeks for a proper culture.
 
will they still wait the proper amount of time & give you the 2nd results?
 
{{{{{{{{ hugs }}}}}}}}}
 
hmmm...well, what i used to tell people having a hard time w/ the meds for TB; get em' down any way you can.  so if it means having some crackers or something if it's supposed to be taken on an empty stomach??? screw it.  i mean, if ya puke up the meds what's the point. 
 
noncompliance is the major issue due to N/V & the length of time of therapy.
 
Tigan helps a lot for nausea.
also marshmallow! (like FLUFF!) :-)   did the doc say to take the meds @ night?
did the doc RX an anti-nausea antiemetic drug?  the doc should...would make things a heck of a lot easier for you.  it's a horrible feeling nausea is.
 
hang in there!

elcamino
Veteran Member


Date Joined Sep 2005
Total Posts : 1744
   Posted 3/8/2007 5:33 AM (GMT -7)   

I don't see my doc for another 3 weeks.  If the nausea continues, I might ask her about an anti-nausea drug.  I see my rheumy next week--if it gets bad enough, he might prescribe me one as well.  I asked the ID doc about taking the  meds on an empty stomach.  She said if I need to do to go ahead and take them with food.  I don't think the empty stomach thing is a sure and fast thing anymore.  Perhaps too many people have problems keeping the meds down. I swear it takes most of a diet coke 12 oz. and 15 minutes to get all those pills down anyway.  No wonder they're so hard on your stomach!  And I'm taking mtx on top of all that (which has been causing GI problems). 

As far as the culture in concerned, I think the results will be given to my doctor.  She'll tell me whether they found anything or not.  The good news is no news--it means I'm not contagious after all.  If i were contagious, the health department knows where I live.  They wouldn't have hesitated to contact me. 

another question for you (thanks for being so patient).  If I do have latent tb that is being reactivated by the enbrel, at what point do I become contagious?  I ask because of the problems I had last summer (when this whole thing started).  I developed a wicked cough 3 weeks after starting mtx.  I wrongly attributed it to the mtx, and went to the pulmonologist, etc....  It wasn't the mtx, nor was it ILD, but now I'm wondering if it was in fact the tb waking up?  If so, was I contagious at the time?  I'm worried about my daughters and husband.  I had a cough for a good 8 weeks, but it was a very dry hack--not the productive cough produced by active tb?

 

Thanks,

El


Current dx: Rheumatoid Arthritis
Suspected dx: UCTD/Early Lupus
Current Meds: Enbrel, Plaquenil, Aciphex, Ultracet, Zyrtec, Allavert-D, Zantac, Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan


erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 3/8/2007 12:41 PM (GMT -7)   
hi El,
 
i would assume that what you have now is secondary TB (a reactivation) whereas primary TB would be a person who was never exposed.
 
usually a Dr. will want to screen all family members.
 
the droplets from TB don't travel too far...and the droplets are what carry the bacteria...if your kids & family have normal immune systems?...i wouldn't worry to much; but, there is single dose therapy for prophylaxis.
 
for you?????  once you begin AX therapy the contagious thing will not be a concern. (but if it is...there's a time frame when it's no longer an issue)
 
i'm not positive what the time protocol is currently by the CDC regarding the start time of AX to the period where TB is not contagious. {but really the contagious aspect usually only pertains to primary infections}  whereas your might be "self contained".  i may be wrong...but i don't believe you'll necessarily be contagious.
 
but do ask the ID doc cuz i'm fuzzy in remembering correctly. (and i'm not finding the answers i want when i reference my texts).
 
the ppd skin test for you may always show +....in fact, it might show + for your family members but that won't always mean THEY HAVE IT...it's just an exposure.
 
does the ID doc plan on screening them?
 
good luck El...{{{{{{{{{{ hugs }}}}}}}}}}}}
 
 

elcamino
Veteran Member


Date Joined Sep 2005
Total Posts : 1744
   Posted 3/8/2007 5:56 PM (GMT -7)   
That's just it, Erin. I don't have a positive PPD. It has always been negative--ID doc said with immunosuppressants it would have been negative anyway. Family has not been screened, but they show no signs. I may call my girls' pediatrician, just in case. So, is secondary infection never contagious? If so, I'm safe, 'cause I can assure you I do not have primary tb.

I'll stop bothering you with questions now :) Thank you for being so kind. I'm going to take a shower and go to bed.

El
Current dx: Rheumatoid Arthritis
Suspected dx: UCTD/Early Lupus
Current Meds: Enbrel, Plaquenil, Aciphex, Ultracet, Zyrtec, Allavert-D, Zantac, Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan


erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 3/8/2007 7:59 PM (GMT -7)   
Hey no problem.
I would never say "never"...I'm sure it's always a possibility to contract secondary TB, especially if the culture shows a virulent strain.
Makes sense about the immune suppressed thing.

Whatever stuff you find out about this from the ID doc let me know...I could use the updates!

rest well
Arthritis Forum Moderator
Active Severe Rheumatory Arthritis. Crohns Disease. A.Chiari Malformation & right brain venous anomoly. Partial Complex Seizures (under control!). MVP & Tricuspid Valve Prolapse. Rheumatic heart & lung. Previous Lymes Disease for 10 years.
Meds: Remicade infusions 300mg Q3weeks; Intra-articular knee injections when needed; Mercaptopurine 50mgQD plus 75mg weekly; Mesalamine 4GramsQD; Prednisone 10mgQD mantainance; Entocort 9mgQD; Meclizine; Augmentin; Tigan 300mg; Reglan; LidoDerm Patches; Diazepam 5mg for AS back spasms; Rozerem 8mg; Dilaudid 4mg tabs for pain. 


Keah
Veteran Member


Date Joined Nov 2003
Total Posts : 7314
   Posted 3/10/2007 2:47 PM (GMT -7)   
El- There is a certain percentage of people who will never show a positive reaction to a PPD even if they have been exposed to TB. I am one. This is what the Docs call Anergic. Not only will I not react to PPD, but I don't react to other common antigens and I wasn't immunosuppressed at the time the tests were done.

After working in an ER where we had the highest PPD conversion rate in the country, I was very upset to discover that I had something that looked like TB on a CXR. My previously undx Crohn's and the accompanying low grade fevers and night sweats had sent me running for a PPD numerous times, but I was always negative. However, there were a few times that I had a mini-reaction which lasted less than 24 hours. It's now believed that in my case, that WAS a positive reaction because I'm anergic.

So, a negative PPD does not really mean much in terms of possible TB exposure. You might want to ask your ID about an anergy panel, just to get an idea of whether ot not you can react. Of course that may not be feasible since you mentioned that you are immunosuppressed.

Another trick of TB is to hide in a lung cavity. In most cases, the infection is long gone and just a scar is left behind and I hope that's the case with you. I came very close to having a bronchoscopy, where the plan was to get to my cavity and irrigate the entire section of my lung. The fluid they suctioned back out would have been cultured. I was told that this would provide a much more accurate result than a sputum culture would give us. Luckily, what was seen on my CXR ended up being on a rib and my CT showed clear lungs. I wish I had found out about that before I was standing in the OR suite ready for my Bronch!

I hope that things keep coming back negative for you and that you can get the nausea under control. Those antibiotics can be very hard and I've known quite a few Nurses and Docs who opted to stop taking them because the side effects were too much to tolerate.

Best Wishes.
Keah a.k.a. Wormy
 God helps those who help themselves.
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elcamino
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Date Joined Sep 2005
Total Posts : 1744
   Posted 3/10/2007 8:19 PM (GMT -7)   
Thanks for info. Keah. It's nice to know that I'm not the only one who shows negative all of the time. My ct scan (twice now) has shown the scars. The problem is, there's a good possibility that it's not simply the scars. From what I've read, tb scars on the lungs can still contain tuberculi in them; enbrel and other tnf-inhibitors can wake the tuburculi up. That's what ID doc is betting on. I thought scars would indicate the infection was long gone too--and perhaps in my case it is--but the only way to be certain is to complete the tb tx. Didn't have much nausea today--think my body may get used to the meds--they work as a great appetitite suppressant!

El
Current dx: Rheumatoid Arthritis
Suspected dx: UCTD/Early Lupus
Current Meds: Enbrel, Plaquenil, Aciphex, Ultracet, Zyrtec, Allavert-D, Zantac, Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan


Keah
Veteran Member


Date Joined Nov 2003
Total Posts : 7314
   Posted 3/10/2007 8:53 PM (GMT -7)   
El, the possibility of there being active TB inside an old cavity is great. Those cavities can be like a bubble containing almost any type of infection, including Tb or even fungal infections and the biologics can cause them to pop and allow the infection to spread.
 
That's why I was scheduled to have the Bronchoscopy to irrigate the area and look for active infection. If you get negative sputum cultures, this might be something to discuss with your Doc - just to make sure. Of course, I can also understand not wanting to do that as I faced the possibility of mine with great dread.

elcamino
Veteran Member


Date Joined Sep 2005
Total Posts : 1744
   Posted 3/11/2007 6:33 PM (GMT -7)   
Oh, I hadn't thought of the possibility of another type of infection than tb? Yes, a bronchoscopy is not something to look forward to--but can it be as bad as a colonoscopy? Heck, I've had 3 of those! Is a cavity the same thing as a scar? My ct scans didn't show any "cavities," just apical scars indicating an old infection, presumably tb.

El
Current dx: Rheumatoid Arthritis
Suspected dx: UCTD/Early Lupus
Current Meds: Enbrel, Plaquenil, Aciphex, Ultracet, Zyrtec, Allavert-D, Zantac, Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan

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