Question:

I have Myasthenia Gravis, hypothyroidism (after RAI-131 ablation therapy for Grave`s Disease) and now Systemic Lupus. My rheumatologist is now recommending that I be seen by an immunologist for persistent febrile illness of unknown etiology (100-101 x/2mos). Incidentally, I`m taking Imuran for the Lupus (50mg/day). I`ve had a bone scan, which was negative.

What does an immunologist treat that my rheumatologist cannot? Is an immunologist able to treat Lupus? I hate to add another specialty to my list of physicians, if it is not necessary.

Thank you for your time and patience.

Answer:

Rheumatologists are trained to take care of patients with lupus. Some rheumatologists take special interest in lupus and other immunological diseases. Lupus is an autoimmune disease, in which the immune (defense) system of the body is purported to act more than it should. Myasthenia gravis is also an autoimmune disease. The basic problem in the immune system in both lupus and myasthenia gravis appear to arise through similar mechanisms. So, immunology is a common mechanistic thread between the two diseases, and an immunologist should ideally take care of both. But, symptoms of lupus are more close to Rheumatology and symptoms of myasthenia are more close to Neurology, and therefore, traditionally, these specialists have respectively taken care of these problems. In your case, there is an additional and a new problem of fever of unclear etiology, which could have an autoimmune basis (uncontrolled lupus itself or an additional one), or could be due to some infection. Additionally, a person in your situation might be more prone to infections, because both lupus and imuran can suppress one`s immune system and predispose one to infections. Sometimes, fever due to lupus may not be controlled by imuran. Sometimes, drugs themselves may cause fever.

Your rheumatologist, like any other physician, would like to get as much help as he/she can get in tackling a complex problem like that of yours. If he/she has a particular physician/immunologist in mind, it may be a good idea to visit a few times for an opinion.

For more information:

Go to the Lupus health topic.