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How are autoimmune diseases detected ?

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Internal Medicine Specialist
Practicing since : 1998
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I am a 27 yo female. I've been having joint pain for several years now. I've seen a rheumatologist twice now, but he doesn't really think I have any rheumatological illness. XXXXXXX is positive (but I have hashimoto's thyroiditis), all else looks okay I'm starting a trial of plaquenil for the joint pain. I have a long hx of GI problems, mostly pain. I've been diagnosed with IBS. Lately I've had moderately severe fatigue. Taking a shower wears me out. I'm having a sleep study soon to r/o apnea. I have frequent low-grade fevers, but nothing above 99 degrees (though I usually run around 97.4) I've been having night sweats for many months, now. I have pain in lymph nodes, especially in neck (I think the parotids are the primary culprits), but the pain moves around. My right parotid might hurt one evening, and the left the next day. Rarely at the same time. I do have dry mouth, but a schirmer's test seems to have ruled out Sjogren's. I have never been able to palpate my cervical lymph nodes except when they are very swollen, so I'm not sure if they are swelling at all. However, this week my supratrochlear lymph node in my right arm hurt severly for about 24 hours. The pain radiated around the arm but was definitely most sever at the swollen area. The pain is mostly gone (it is tender when I palpate it, but I can move my arm without any discomfort). I can't tell if it is moving (it doesn't seem to be, but maybe I am noticing more than one lymph node and they are matted?) , but I can palpate it and know that it is swollen. When I feel the same area on my left arm, I feel tenderness but cannot feel any swollen areas. The hard area on my right arm feels like the density of a strong muscle. I'm also having increased lower back pain. Do I need to contact my general practitioner re the lymph nodes, or can I just wait and see how the plaquenil does? I don't know of any infections, and it seems odd to me that the swelling and tenderness are pretty much unilateral. One of the doctors I work with seemed to agree with the latter. I am already in the medical offices frequently and would rather not spend more time/money there than I must.

Thank you very much.
Tue, 24 Apr 2012 in Bones, Muscles and Joints
Answered by Dr. Jasvinder Singh 7 hours later

Thanks for posting your query. I am really glad to help you out. I can understand the agony you're going through.

I would suggest to go for biopsy of the lymph node rather than waiting. Hence see the right doctor whether it is your GP / Surgeon.

My reasons are:
A positive XXXXXXX test is suggestive of an autoimmune disease. The XXXXXXX may not entirely be attributed to Hashimoto's thyroiditis (although Hashimoto's is an autoimmune disease).

The possibility of other autoimmune diseases like Lupus, rheumatoid arthritis, scleroderma, polymyositis, mixed symptoms which you've mentioned like low-grade fever, fatigue, joint aches are suggestive of an autoimmune disease.

However, other causes of the lymph nodes like tuberculosis & lymphomas also need to be looked into. The mentioned 2 diseases can present with low grade fever, night sweats, fatigue etc.

For the same, you should get a biopsy of the lymph node done and a CECT chest and abdomen done to look for the presence of lymph nodes at other sites and their character.

The presence of lymphadenopathy should not be taken casually and needs to be aggressively investigated.

If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.

Wishing you good health.
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