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Multiple sx, nuro sx, white spots on brain, lupus, SLE

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I m not sure what kind of dr to see or if I should/or can wait to get in to see a nuro/rhum. I have had multiply sx for years it first started as nuro sx. I have seen at least 5 nuro dr. over the years all test neg. except positive XXXXXXX and some white spots on mri of the brain which have been no concern. Over the years the sx. have increase to more rhem. I am getting no where with my rhem. dr. all test neg. for lupus she said and to go back to another Nuro and a second opinion from another rhem. and to a dermatologist and a massage. Sx. now that my rhem knows about also....Hands/fingernails-nodules on joints, nails pale with very dry over grown cuticles, won t grow, white marks scaly patches on hands and feet, chronic plantars fasciitis (1year-2 podiatrisits), joint pain in Am that goes away, pain in the whole back while sleeping and during the day that varries through out the day/days, red v rash/shawl rash and upper arms comes and goes with severity in color, sudden chest pain with upper back tighness and it felt like a lump in my throat, lasted 20-30 min. NOW my disk are bulging in my spine by my neck. I have new sx they arive daily!primary said to follow rhem. direction & go to the ER if chest pain happens again. QUESTION what kind of Dr. should I see? (I am going to the Derm. next week). I think my Dr is just focused on Lupus and not looking into anything else, do you agree? She said Lupus dosen t cause back pain and all my test are neg. except XXXXXXX Do I just jump to a hem/onc? I think they are over looking something in my blood. Or try another nuro because of all the back pain? I am on Plaqunil, anti-inflamatory, zoloft, prednisone since 2 months ago!
Posted Wed, 2 May 2012 in Lupus
Answered by Dr. Bharat Chawda 17 hours later

Thank your for the query,

In lupus we see multi system or multi organ involvement. SLE is a great imitator. So at times we need to consult different departments and take a combined opinion from all of them.
In lupus, skin involvement is of specific and non specific types. Malar rash(rash over cheeks) and photo-sensitivity is one of the specific type of involvement. There are 11 criteria suggested by american rheumatic association, out of which 4 or more symptoms if seen is taken as positive.

Those 11 criterias are:
1) malar rash
2) discoid skin rash
3) photosensitivity
4) arthritis
5) pleuritis or pericarditis
6) kidney abnormalities
7) brain involvement
8) low blood counts
9) anti-DNA or anti-Sm antibody,anticardiolipin antibodies
10) positive XXXXXXX test
11) ulcers over lining of the mouth, nose, or throat.

You have certain symptoms of SLE and that the reason your doctor is treating you on these lines. Now to answer your specific questions:
1) You should consult a dermatologist and a rheumatologist both and take their opinion. They may give referral to cardiologist or a physician.
2) you have to check the 11 criteria to think of SLE. You should also rule out rheumatoid arthritis & dermatomyositis(we see nodules over fingers in this).
3) You can take a second opinion from other doctor(a dermatologist would be better).

Hope this answers your query. In case of any doubts, I am available for the follow ups.

wish you good health.

Above answer was peer-reviewed by
Follow-up: Multiple sx, nuro sx, white spots on brain, lupus, SLE 13 hours later
Dr. Chawda,

Thank you for your reply. Both of the Rheumatologis I have seen do not think it is Lupus related that it is neurological related and the five Neurologist have said it is Rheumatically, so there has been "no combined opinion" with either specialist, or any other referral of seeking a different specialist, only the recent Dermatology referral, (I have an appointment this week). I am just getting bounced back and forth between Rhematology and Neurology, meanwhile I am continually getting more and more symptoms.

How do I eliminate this ripple effect?

In this short medical review, I did not mention that I have had the Harlequin Sign, that was noticed when I was an adolescent, most likely congenital; I was born with one eye shut that resulted in ptosis with one sided muscle weakness that eventually dissipated. Through adolescent years I have had sporadic muscle cramps, nose bleeds after exercise, skin rashes, odd sense of movement while laying down, sensitivity to cold, odd marks under nthe skin, neck/back pain among all the other symptoms that I have previously noted. Nothing showed on any of the neurology exams that were previously done.

Could that still have a relation to the medical issues I have now?
Answered by Dr. Bharat Chawda 23 hours later

Ok, you had pretty comprehensive evaluations by several Neurologists and Rheumatologists.

You had not mentioned the XXXXXXX titres. Positive XXXXXXX is not specific, it cannot suit to be a screening test. In the absence of specific Antibodies it has no significance. It does not necessarily indicate a Rheumatological disease. However the physician should keep XXXXXXX associated diseases at the back of his mind while working with you.

With the other symptoms that you explained some go towards an autoimmune disease but no clues on lab tests is worrying.

As a good process a primary personal physician should verify your problem and do referrals to concerned specialists as and when suspicion arises and take it back. Based on the other specialist opinion he can do a second referral to another specialty. It is not a sound practice to see the specialists directly and refer to a different specialists. The person would lose confidence in everyone and the system of medicine. I would never do that. See the dermatologist and let him express his views. Meanwhile try to find a good personal physician in your area seeking help of the residents in your locality / web.

I shall refer and let you know if anything comes up my mind.
Above answer was peer-reviewed by
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