MCAS & Autoimmune Disease

In this essential Lunch & Learn episode, Dr. Kara Pepper sits down with her friend and colleague, Atlanta-based rheumatologist Dr. Mala Kaul, for a deep dive into the often-misunderstood world of autoimmune disease, hypermobility spectrum disorders (including EDS), mast cell activation syndrome (MCAS), and POTS. Together, they unpack what to expect when seeing a rheumatologist, which labs matter (and which ones don’t), and how to navigate the uncertainty when symptoms don’t yet have a name. This conversation is a must-listen for anyone living with chronic pain, rashes, unexplained fatigue, and multi-system symptoms—especially those newly navigating a potential diagnosis of MCAS, hypermobility, or autoimmune conditions. Key Topics Covered: Why MCAS, EDS, and POTS often go unrecognized—and how that's changing The role of a rheumatologist in evaluating complex cases of chronic pain and fatigue What makes autoimmune diagnosis so nuanced and often delayed How to advocate for yourself and research providers before making an appointment Which lab tests (e.g., ANA, thyroid, vitamin D, iron) are helpful—and why interpretation matters more than numbers How inflammatory arthritis differs from pain caused by hypermobility The difference between clinical and measurable diagnoses Why some patients may need ongoing monitoring without immediate treatment The risk-benefit conversation around immunosuppressive therapies Practical Takeaways: Start with a trusted primary care physician who’s willing to look at the big picture—even if they’re not well-versed in MCAS or hypermobility. If you're seeking a rheumatologist, do your homework—call ahead to ask if they’re familiar with MCAS or EDS. Lab tests are tools, not answers. Don’t panic over results until they’ve been interpreted in the context of your symptoms. Diagnosis takes time. The immune system often reveals itself slowly. Don’t give up if you’re still in the gray zone. Surround yourself with a care team that listens and is open to evolving information and your lived experience. About the Guest Dr. Mala Kaul is a board-certified rheumatologist based in Atlanta with over 20 years of experience. She’s launching a new, integrative practice model to better serve patients navigating complex autoimmune and inflammatory conditions. You can find her on Instagram at @integrahealthmd and on Facebook at Integra Health.