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Discussion Starter #1
Hello,

I have read so much about how a skin biopsy can determine if someone has lupus or not. How true is this? Is this true with all of us?

If that would give all of us a dx when in question, why don't doctors do this more? If it is that accurate, I don't understand why it isn't done more.

As some of you know, I am frustrated like so many others here as to what is wrong with me. I am being treated with medication the same as someone with a dx of lupus/sjogrens but still not knowing for sure is so frustrating! I don't like the thought of a skin biopsy but I am sure I am not alone when I say I would go through it if it would tell one way or the other as to what is going on with me.

I would appreciate it if someone could clear this up for me. How accruate is this test, is it only accruate for some lupus people but not others?

Confused!!! :rolleyes:
Janice
 

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Hello Nana,

A skin biopsy can be very helpful in diagnosing Lupus as well as many other skin diseases. I am probably partial to such methods, because I am a Pathologist and that is what we do:wink2: . A biopsy is where you actually "see" the diesease in action (Fascinating!) Naturally no method is 100%. Diagnosing Lupus is like putting together a puzzle. The more peices that come together, the more you begin to see a recognizable picture. The biosy is realitivly painless and easily done in a few minutes in the doctors office. Sometimes several samples will be taken from different locations (usually an area that shows a rash, from the forearm or neck, and from the buttocks or other "non exposed" area.)

For some people the diagnosis is so obvious a doctor will not bother with a biopsy. When the rash so classic is, the ANA and other lupus typical antibodies are strong positive, along with signs of systemic involvement. On the other hand when it is not so clear, or when other skin conditions could be confirmed or ruled out by biopsy, it is extremely useful. Most forms of Vasculitis for example are (froma pathologists viewpoint) only confirmed by a positive biopsy. Here biopsy is considered the "gold-standard" in diagnosis, eventhough several of the Primary vasculitides are strongly associated with anti-bodies (ANCA) and other laboratory findings.

By all means I would have the biopsy. If you don't have Lupus, the biosy might be diagnosic of "something else" and if it strongly suggests Lupus or auto-immune involvement, I can be a very important peice in that puzzle, along with your other documented symptoms, Lab results, and response to the treatment.

You write that you are currently taking medications.... I am not sure how this could affect the biopsy findings. Of course things like cortison can render a biopsy useless. You should stop all possible "disease modifying medications" und abstain from using skin-care products on the "to-be" areas several weeks in advance.

I wish you lots of luck, and hope that you don't need to give up a pound of flesh, to get an accurate diagnosis.:)

Grüß
Monique
 

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Hello again,

I guess this is a good place to share a little story of mine, that really tickeld me. I have MCTD and one of the ANCA associated primary vasculitides (MPA). As a result of my vasculitis I have had several necrotic lesions on my legs (ulcers). these lesions often need to be "surgical cleaned out" freeing them from the dead tissue in order to promote the healing process. After one of these procedures a sample of the tissue was sent to the pathology for evaluation. That same day a fax labeled URGENT came to the clinic from the pathologist.

Upon examing the sample (the pathologist knew only my name, my age, and my sex) He had no information about my known diagnosis, nor had he ever seen me in person. He wrote that he saw in the tissue a prominent vasculitis in several small arteries and in some of the "healthy" surrounding capillaries. He wrote that such an "obvious" finding of vasculitis was indicative of a systemic process and question whether there were other signs of systemic involvement (ie. kidneys, or lungs)! To which the answer is yes.

I was so impressed by this observation, He guessed my diagnosis simply from examing a small peice of my skin under the microscope. I always say the pathologist always gets the right diagnosis in the end (unfortunatly then it is often to late to do anything about it!:hehe: after the autopsy)

Ciao,
Monique
 

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Hi:

To add my 2 cents worth. I am a serum negative Lupus patient. I was fine, then I developed a rash on my arm, it was persisten and wouldn't go away, so I went to a dermatologist. He biopsied the rash, it came back positive for "tumid" lupus. The dermy did 2 more biopsies and a series of blood tests. These biopsies were from non-lesion non exposed skin (buttox and under side of arm), these came back positive as well.

Started Plaquenil, within 6 months, I had developed systemic arthritis and sever headaches. Went to a Rhumatologist - I'll skip the first - and he ran more indepth blood test, I was DX with serum negative Lupus SLE, SCLE and APS. Over the past ear I have now shown Sjogrens, Reynards, Possible RA (All serum negative) and I am now consistently leaking protein and Red blood cells from my kidneys (see the dr again on wednesday to decide what's next)

I am now on Prendisone, CellCept, Plaquenil, Cymbalta, Ultram and Vicodin.

If my Dermy did not do the biopsy, I would have had a much harder time getting a DX and treatment. I have only had one positive ANA (just before I started showing possible RA) an occasional low C3 and/or C4, high CPK's, and ever rising ImG. There is some new stuff now but still nothing specific to lupus screening.

So if you are struggling for a DX, and you have a visible rash, let the Dermy biopsy it. They freeze the area, take a small skin punch (about the size of a pencil point) which doesn't hurt at all. It is very worth it!

Hope this helps - Stephanie
 

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Discussion Starter #5
Thank you Monique and Sam for your replies.

I appreciate you taking the time and your replies were very helpful. I sure wish there was one simple test that would tell our dr.'s yes or no we do or do not have lupus, etc. I do feel bad for our dr.'s who are trying to figure things out but sometimes it gets so frustrating and you just want to sit down and have a good cry! Or like me, get on here and ask a million questions! :)

It is a good thing everyone here is so nice and helpful. This site is so wonderful to have.

Thank you again,
Janice
 
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