A new wrinkle

I have been seeing a rheumatologist now for 5 months with newly diagnosed PsA. During some of my initial lab work a serum protein electrophoresis was done. It showed low gamma globulin. This was segmented out and shows I have low IgG 2, 3 and 4. My IgG 1 was normal. Now I have an appointment with an immunologist. Does anyone else have anything similar? The rheumatologist suggested the two might be related, but this fact would definitely impact what medication I will be able to take. (biologics will be out) I have not run across this information in any of my own research.

Awww… that’s way too technical for me to chime in on… I hope someone else can pick this up for you :slight_smile:

Don’t know what the numbers are but lymphocytopenia which is the end result of low lgg,2,3,4. is certainly indicitive of a number of Autoimumune diseases. PsA isn’t necessarily one of them but can be. My grandaughter for what its worth has the same low counts and does have PsA but they are also kicking around Lupus. Did he tell you Bios were out? Lg numbers have to do with B cell and t cells and are also used to diagnose RA which use Biologics.

that is also a VERY sensitive test and the numbers can be skewed easily so would certainly have a repeat before getting too deep. steroid use for only a few days for example will drop them like a rock as will a number of viruses.

I know it’s technical, but thank you for your response tntlamb. The rheumatologist is doing a challenge of my immune system with a pneumococcal vaccine. We will repeat all of the IgG’s in one month. He wants to see a huge immune response. If not, he said Biologics will be out. Because of my own limited immune system coupled with the immune suppressive activities of the biologics he said it would be too much of a risk for big infections. I am currently on Methotrexate, which also has some immune suppressive activity. I am a little worried that my options will be really limited in treatment of my PsA.

Hi Steen, boy, that’s a tricky one! It gave me a bit of a fright initially as my IgG is marginal, and I was thinking - goodness, I hope they don’t take my Humira away if my next SPEP comes back with a low IgG!

After a bit of investigation though, it seems that whether biologics are ruled out (in my case at least), depends on the reason for the low IgG - for example, in my case, the nasty that is causing the low IgG, also thrives in a high TNF alpha environment, so they don’t usually withdraw an anti-TNF.

Do you have an idea yet if it has an underlying cause, or is considered to be idiopathic?

No, I am not sure of the underlying cause. I am hoping my immunologist can explain this to me. Thanks for your input, it will give me another avenue to investigate.

[quote=“steen, post:6, topic:7390”]me
me another avenue to investigate.

My son had low IgG levels when they were checked at age 2 due a chronic infection problem. We were told his problem was THI (transient gammaglobulinemia of infancy) and usually went away by age 5, when levels would eventually normalize. In the meantime, he had to have extra vaccines,as some of his titer levels were not optimum for his age and the number of boosters he had already received. Basically, he was not keeping his immunity after each vaccination.

Fortunately, his IgG levels (Ig2 and Ig3) did go up, and his total IgG normalized by age 5. From age 2-5 though, we had to be extremely cautious about so many things, even having him only eat grass-fed beef in order to lower his risk of E Coli contamination. He never was able to maintain an immunity to his PneumoVax vaccinations, and we may never know why. His infections did stop occurring so frequently, so we just counted our blessings.

I know it’ a confusing aspect of medical science though, and I’m sorry I don’t know how it may relate to autoimmune disease.