Question: My dermatologist diagnosed SLE and Sjogrens in 09/2009. First rheumatologist concurred
in dx but I had to change rheumy due to his personal illness. New rheumy agrees
about Sjogrens but not 100% sure about SLE as I have no obvious organ
involvement or overt RA issues. The Sjogrens is becoming more pronounced.
Because of a reddish "blotch" on my upper left left arm, my rheumy sent me back
to the dermatologist. In addition, I have now begun developing edema in my
upper left arm. They have done a couple biopsies as they aren't sure what it
is. The preliminary dx is lymphederma. There is a 3" difference in
circumference between upper arms.
My research into this doesn't yield much info into a Sjogrens / lymphederma
connection - especially in the upper arm. Any suggestions or ideras?
Apologies for delayed response. Lymphedema/lymphederma is not something we usually associate with autoimmunity and is not something I've seen in Sjs even with pseudolymphoma and a high lymphocyte burden. However, anything that blocks lymphatic drainage such as enlarged lymphnodes possibly could lead to lymphedema. Also, if there was inflammation or infection in the lymphatic system this could have the same result. However, in my experience this is not seen.
An erythematous patch on the skin could possibly be morphea (thick connective tissue), and if the process was deep enough could possibly interfere with lymphatic drainage. The skin bx would have shown increased fibrous tissue, unless it was very early in the process, where edema is the more pronounced feature.
If you reply with the results of the skin bx and any autoantibody data, I may have further thoughts.
I am assuming your primary care physician has ruled out any other causes of a lymphatic blockage