[PAGID] Patient question

[Chris Seroogy]

Dear Colleagues,

I have a rheumatologic question on a very complicated CVID patient and am
hoping some of you have faced this management challenge before.  This is a
13y/o female with long-standing brittle type I DM, CVID (mostly functional
antibody production problems and IgA deficient), Pierre-Robin sequence, and
multiple drug allergies.  She presented to my clinic for second opinion re:
CVID management last Fall and at that time I noted significant arthritis is
several large joints and synovitis was confirmed by MRI and several bony
erosions were seen on plain xray.  Since this time, I have been treating her
arthritis (seronegative) aggressively with poor response.  She is on MTX and
humira, low dose daily prednisone.  She did not respond to Enbrel for 12
weeks, hence was switched to humira.  She receives IVIG every 3 weeks (she
has problems with recurrent sinusitis.) Despite this management, she has had
significant progression of her arthritis now involving most joints and daily
pain.  I am not sure where to go next (thoughts are anakinra, bolus
steroids--although challenging with her DM.)  She was seen by our ID group
and her clinical picture/findings were not felt to be secondary to an
infection.  She also had a negative bone scan.  I welcome any thoughts.
Regards, Chris


Chris Seroogy, M.D.

Assistant Professor

Dept. of Pediatrics

Mail:  H4/474 CSC, Mailstop 4108

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Madison, WI  53792

phone: 608- 263-2652

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