Jane X
Jane has two rare autoimmune diseases. Primary biliary cholangitis, affecting her liver, developed in 2005. Then, after several years of additional symptoms, MPO positive AAV was diagnosed in 2017. Jane has learnt to enjoy life at a slower pace.
Jane says that, by the time vasculitis was diagnosed, she had made so many adjustments to her life she had forgotten how it felt to be well. Before giving up her career as a pharmacist, for example, she had hired a cleaner and a gardener and was buying ready meals. Her symptoms also came and went in unpredictable ways and had increased gradually. As a result, she suspects that at medical appointments she underplayed how bad things were.
As Jane grew up seeing the effect of rheumatoid arthritis on her mother, she half expected she might develop that condition herself. Instead, in 2005, a rheumatologist identified that fatigue, bone pains and achiness were a result of primary biliary cholangitis, a rare autoimmune disease of the liver. Once diagnosed, this was managed well with standard treatment that didn’t involve suppressing the immune system.
In 2012, Jane’s liver doctor suspected that sores on her fingers were a sign of vasculitis, so sent her back to rheumatology. Unfortunately, Jane recalls the sores being described as a trivial matter that didn’t require additional treatment. She says this was followed by several years of fatigue, joint pain, sores on her fingers, and red eye, during which her liver condition became less well controlled. In 2013 Jane had the first of what she calls an attack where the pain and stiffness escalated over a few hours to the extent she couldn’t move without help.
Throughout, Jane’s GP listened, knew that something was wrong, and arranged investigations. But the way the symptoms came and went, usually in the middle of the night, made it a challenge. Jane turned into a bit of detectiv by writing down what was happening and taking photographs of symptoms that could be seen. The vasculitis diagnosis was pursued following a rheumatology appointment where she had a very visible sore; she therefore wonders if videos might have been better at helping doctors understand earlier what was going on.
After being diagnosed with MPO positive ANCA associated vasculitis, Jane was prescribed immunosuppressive treatment – steroid injections and azathioprine – which she found transformative Although she has to pace herself, she has more energy and can get much more done. Before treatment, she says she would start a family roast dinner and they would end up with meat sandwiches; now she enjoys cooking, gardening, knitting and walking, and is learning Welsh.
In addition, as Jane had been ill for a long time, she worked with a qualified rehabilitation exercise instructor to get her strength back. She progressed from an older person’s chair exercise class, to over-50s circuits, to aerobics, which is continuing online during the COVID-19 pandemic.
Although Jane had empathy for people who are chronically ill through seeing the impact on her mother, she says she hadn’t realised the loneliness and isolation that it can bring, even when you have family around. Both before and after diagnosis she has found patient groups a source of hope, and appreciates the support and time they offer.