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Feeling fatigued and suffer joint pain. Blood report showed elevated serum complement. Cause for joint pain?

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Hello, I wonder if you can help. I have been feeling extremely fatigued (can only function 2-3 hours a day) and am suffering with joint pain over the last 4-5 years and this has worsed significantly recently. My blood test results from 3rd XXXXXXX 2013 show elevated ESR (23) and elevated Serum Complement C4 (0.71) and ANF screen is positive. C3 complement is just on the border of being elevated at 1.65. Lupus and Rheumatoid Arthritis are showing as negative. Please can you tell me what could be causing my joint pain (knee pain has been particularly bad with swelling this week) if Lupus and RA are showing negative? My face went extremely red (like a butterfly rash) 2 weeks ago when I was outdoors (18 degrees) and this has never happened before, however as stated above Lupus Anti coag screen is negative in my blood test. I would be grateful for any advice as to how to cope as I am starting full time work next week and am worried I will not be able to work a full day due to exhaustion and low grade fevers. Thank you, Ms XXXXX.
Posted Sun, 7 Jul 2013 in General Health
Answered by Dr. Jorge Brenes-Salazar 37 minutes later

Thanks for your excellent summary and good quality pictures. The fact that lupus anticoagulant screen was negative DOES NOT exclude lupus as a diagnosis; as a matter of fact, I strongly would consider that possibility in your case given your young age, female gender, slowly progressive symptoms and of course, the unprovoked rash which to me is a butterfly malar rash until proven different. For the diagnosis of systemic lupus, you need to fulfill 4 of these 11 manifestations in any combination:

1.Malar rash (rash on cheeks)
2.Discoid rash (red, scaly patches on skin that cause scarring)
3.Serositis: Pleurisy (inflammation of the membrane around the lungs, usually pain when breathing) or pericarditis (inflammation of the membrane around the heart with chest pain)
4.Oral ulcers (includes oral or nasopharyngeal ulcers)
5.Arthritis: nonerosive arthritis of two or more peripheral joints, with tenderness, swelling, or effusion
6.Photosensitivity (exposure to ultraviolet light causes rash, or other symptoms of SLE flareups)
7.Blood—hematologic disorder—hemolytic anemia (low red blood cell count) or leukopenia (white blood cell count<4000/µl), lymphopenia (<1500/µl) or thrombocytopenia (<0000/µl) in the absence of offending drugs Hypocomplementemia is also seen, due to either consumption of C3[54] and C4 by immune complex-induced inflammation or to congenitally complement deficiency, which may predispose to SLE.
8.Renal disorder: More than 0.5 g per day protein in urine or cellular casts seen in urine under a microscope
9.Antinuclear antibody test positive
10.Immunologic disorder: Positive anti-Smith, anti-ds DNA, antiphospholipid antibody, and/or false positive serological test for syphilis; sensitivity = 85%; specificity = 93%.[53] Presence of anti-ss DNA in 70% of cases (though also positive with rheumatic disease and healthy persons
11.Neurologic disorder: Seizures or psychosis

So XXXXXXX please make note that you already fulfill 4 of these criteria: 1) Positive ANF 2) Malar rash 3) Arthritis (evident by just looking at the pictures) 4) Photosensitivity (rash happening outdoors where there is UV light).

I would strongly recommend you to visit a rheumatology specialist for an examination, bring your pictures as well so he can see them.

Yours truly,

Dr Brenes-Salazar MD
Mayo Clinic MN
Above answer was peer-reviewed by
Follow-up: Feeling fatigued and suffer joint pain. Blood report showed elevated serum complement. Cause for joint pain? 25 minutes later
Dr Brenes-Salazar

Thank you for your prompt response. I will ask my GP to refer me to a rheumatology specialist.

May I ask, in your opinion, taking in to account the above, do you consider it more likely than not that I am suffering with Lupus?

Yours truly


Answered by Dr. Jorge Brenes-Salazar 18 minutes later

In my experience, patients who fulfill 4 of those Internationally accepted diagnostic criteria in the absence of an alternative explanation have been diagnosed with lupus; again, everything has to be but into context but there are other clues in your case: extreme fatigue (most common symptom reported in patients with rheumatologic disease), your age, your gender.

I hope I have been of help, wish you the best,

Truly yours,

Dr Brenes-Salazar MD
Mayo Clinic MN
Above answer was peer-reviewed by
Follow-up: Feeling fatigued and suffer joint pain. Blood report showed elevated serum complement. Cause for joint pain? 21 hours later
Thank you, you have been very helpful.

Kind regards

Answered by Dr. Jorge Brenes-Salazar 8 hours later
wish you the best XXXXXXX
Above answer was peer-reviewed by
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