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Have positive ANA, numbness and tingling in limbs. History of drug induced lupus. Next step?

Hi I m a 28 year old that has a positive ana 1:360 nucleolar. My compelement levels of c3 and c4 are slightly low. My ENA panel was negative. CK is normal, crp normal, vitamin d normal I have the following sypmtoms: joint pain to wrists, ribs, si, neck, tmj raynaud s onset about 1 year ago No skin thickening, hair loss or rashes other than itchy hives (that leave hyperpigmentation after they fade) if I eat food that I ve tested to be allergic to dizziness numbness and tingling to hands and feet; more prononounced to the left hand headaches history of drug induced lupus related to isionizid, IBS, dilation of espophagus as a child chest tightness relieved with adjustment of the ribs productive small amounts of clear thick sputum with scant amounts of black streaks no adventitious sounds to the lungs Slow swallowing of solids intermittently (I m not sure if I m just hyper aware of everything or if this just because I have been stressed and am anaylzing ever possible symptom). No confirmed history of family members with autimmune disorders What would be the next step in diagnosing my condition? A biopsy of a hive?
Asked On : Mon, 24 Dec 2012
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Rheumatologist 's  Response
Good evening mam. From what you describe it looks like Scleroderma with mild overlap of Lupus. Although skin thickening is not there( Sine Scleroderma), which is the characteristic the rest do fit into it.The Nucleolar pattern of ANA, Difficulty in swallowing, Cough production, Raynauds, Arthalgia very much fit into the diagnosis. CK,CRP all can be normal if you dont have the manifestations of muscle involvement. You dont need a biopsy as such cause it is more of a clinical diagnosis. YOu can get a nail -fold capillaryscopy done which will help confirm it and also an HRCT Chest. Even though lung sounds are absent mild changes can appear in the HRCT much before. I think these tests and the clinical picture should suffice for the diagnosis. Hope the information was helpful
Answered: Mon, 21 Jul 2014
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