Brief Answer:
Nsaids initially, SLE should be approached in light of clinical data.

Detailed Answer:
Hello XXXXXXX ,

The most distressing aspect for patients is , not knowing what their exact diagnosis is. I am sorry you had to go through a hard time. I want to assure you that I am here to help and you can trust me.

Let us approach your issue logically and in sequence.

I re visited our previous conversation regarding the investigations you sent in which you tested positive for ANA and ds antibodies. You complained of headache, photo sensitivity, breathing problems and joint pains.

On a first appointment based on your tests, the doctor should have assessed for skin manifestations , oral ulcers, arthritis evidence ( for symmetrical joint swelling of wrists and MCP joints ). A chest x ray should have been done to look for any pleural effusion.

Remember, if a positive ANA test is associated with arthritis ( of the nature that I explained ) , skin manifestations, pleural effusion and proteinuria then one should go for the renal biopsy. If its a positive ANA test with no symptoms then its most likely a false positive. If Arthritis and pleurisy is present then NSAIDs should be started to reduce inflammation. Rheumatoid arthritis is mainly a clinical diagnosis. Labs ( anti ccp antibody, ESR, RF, synovial fluid analysis) and imaging ( x rays of joints involved to look for erosions ) help confirm the overall diagnosis.

Low levels of vitamin d can be clinically silent or present mainly as fatigue and muscle aches. Severe deficiency can manifest as bone pains.
25-hydroxyvitamin D (25[OH]D) levels can be done to look for possible deficiency.

You may discuss your experience and your lab results whenever you go for your clinical appointment for the second opinion. I will be more than glad to assist you along the way.

Let me know if you have any query / clarification.

Wishing you best of health.

Dr. M.S. Khalil

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Brief Answer:
no renal manifestation, more info required on meds and weight gain,

Detailed Answer:
Hello again,

If the 24 hour urine is normal then taking into consideration your previous results you can be sure that there aren't any renal manifestations ( lupus nephritis )which is the most dreaded part of SLE and is quite difficult to treat.

If the vitamin d levels are marginally low then there is no need to worry. Adequate Sunlight exposure and vitamin d supplements for a couple of months are all that would be needed.

You can repeat the ANA and ds tests from another lab for confirmation. I would advise you to do an sm antibody test in addition, in consult with your doctor. Even though the symptoms are present, symptoms alone or ANA and ds alone aren't sufficient to label you as a lupus patient.

You are justified to refuse being treated by a doctor if due courtesy is not given to you and all your apprehensions aren't addressed. Though an online interaction isn't a substitute, if you were my patient, I would advise your next step to be an empiric round of NSAIDs ( celecoxib or diclofenac sodium) for two weeks to see for improvement. A second opinion from another Rheumatologist should be sought as you are still experiencing pain in your hands and paresthesia ( tingling sensations. If Lupus , R.A , Gout and spondyloarthropathies are ruled out then you should limit the consultation to an internal medicine specialist (General Physician).

To answer your question, Yes its possible for both ANA and ds to be positive even in the absence of disease. As explained in the previous answer , false positive results can occur.

You mentioned that you are using other medications , too and you are concerned about weight gain and a great deal of hair loss. I would like to gather some more information before commenting on these two issues.

Please state your height and weight to calculate your BMI. Please list all the medications that you are using currently.

Let me know if you have any query.

Thanks.
Dr. M.S.Khalil

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Brief Answer:
ANA titre wasnt mentioned in the test results.

Detailed Answer:
Hi,

The ds antibody though positive , can be repeated as less than 10 I.U was considered indeterminate range. You had 11 I.U.

The ANA screening test you uploaded , did not mention or quantify the titer with which you tested positive. When ANAs are present in normal people they are in low titer i.e less than 1:80.

Let me know if you have any query.

Thanks.
Dr. M.S.Khalil

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Brief Answer:
You are welcome.

Detailed Answer:
You are most welcome.

Let me know if you need any other clarification.

Thanks.
Dr. M.S.Khalil

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Brief Answer:
No, its not.

Detailed Answer:
Hi,

No, it is not. TSH ( Thyroid stimulating Hormone ) levels are not present in the lab results , you uploaded.

Thanks.
Dr. M.S.Khalil

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Brief Answer:
Yes, TSH will complete the TFTs.

Detailed Answer:
Yes, you already did the T 4 and T 3 tests. A TSH alone would suffice to complete the thyroid function tests.

Let me know if there is any other query.

Best of luck, on Monday. You may close the discussion and rate the response , if there is no further query.


Thanks.
Dr. M.S.Khalil

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