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Worried about upcoming rheumatologist appointment
Autoimmune Diseases | Last Active: Mar 5 2:21am | Replies (52)Comment receiving replies
Good advice. Skin biopsies can confirm the diagnosis of vasculitis
and point to appropriate treatment. A dermatologist at a referral center may be the best specialist to make the diagnosis and head the team management.
Replies to "Good advice. Skin biopsies can confirm the diagnosis of vasculitis and point to appropriate treatment. A..."
...an additional note if you go down the WAG, cutaneous vasculitis biopsy pathway
+ choose a dermatologist or dermopathologist who understands the subtilties of sampling for cutaneous vasculitis
+ Here’s an open access 2010 classic on “The histological assessment of cutaneous vasculitis”
https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2559.2009.03443.x
+ cPAN subcutaneous vessel damage is focal and evolves over time
+ my experiences
In retrospect, there was an element of good fortune in my diagnosis process: my wizened dermatologist knew that my livedo reticularis and subcutaneous nodules were “rare”, and he referred me to an expert dermopathologist for the 2007 biopsy. That physician spent what seemed like an inordinate amount of time choosing the ‘optimal nodule’ to biopsy.
Earlier this year I had a flair and a less-experienced derm, and I, didn’t know to biopsy the center of my obvious, circular livedo reticularis pattern (see page 8 of above url or Figs 3 & 4 in https://www.frontiersin.org/articles/10.3389/fphys.2020.00994/full) Though the biopsy was negative, the immediate reaction, 2-months later, of the vasculitis dermatologist consult was “classic cPAN.”
If I ever need another biopsy, I know to grill the physician about his/her knowledge of productive sampling for cutaneous vasculitis.
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Be thankful you got an appt. Be confident in why you think you need to be seen.