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Lupus or Not?

Posted Nov 22 2011 12:00am
I had my appointment with the "specialist" today.  I put quotation marks around "specialist" because I'm using that term loosely. It turns out that she was another dermatologist in the same practice who sometimes sees patients with cutaneous lupus, which I'm pretty sure I don't have because I do not have the typical scaly rashes associated with the disease.  I was expecting someone who was actually familiar with autoimmune diseases in general, including the systemic version of lupus. 

Here's why I think the doctor did not do a good job. My blood pressure and temperature were never taken.  I was wearing jeans and a sweater, yet she never asked to examine my skin. She did not examine my nails (which, by the way, are soft and have some pitting). She never looked at my scalp or examined my hair (which I'm losing), which was my main complaint to begin with. She never asked about my energy level (terrible fatigue), lymph nodes (they're sore), any rashes (eczema and past photoallergic reaction), etc., etc., etc.

What she did do was tell me she didn't think I had lupus or any sort of autoimmune disease....based on what? I'm not sure.  She simply said I didn't fit the criteria. Considering she didn't ask me many questions or do any examination at all, I don't really know what "criteria" she was referring to.

I can only guess that she was referring to the lupus diagnostic criteria developed by the American College of Rheumatology; however, she never asked me about most of those symptoms, and I'm pretty darn sure it's impossible to know how someone's urine is doing without a test.

Don't get me wrong. I don't actually want lupus.  Heck, I don't want CFS/ME or anything else for that matter.  I just want to know what's wrong with me, and I would like a doctor to be thorough. If I'm seeing a dermatologist, I would expect that person to examine my skin, hair, and nails. She did exactly none of the above.

What she did do right was order some appropriate follow-up tests  (in no particular order)
  • Anti RNP: often found with many autoimmune diseases
  • Anti Ro/SS-A and Anti La/SS-B: often found in people with Sjogren's syndrome or cutaneous lupus
  • Anti Scl-70: often found in people with scleroderma
  • Rheumatoid factor: high levels often found in people with rheumatoid arthritis
  • Anti double-stranded DNA: found in 30 to 50% of people with lupus
  • C3 and C4 Complement Proteins: low levels may indicate active lupus (or other infections)
  • C-reactive protein: high levels indicate inflammation, people with active lupus or other types of inflammatory diseases or other infections often have high levels
  • Erythrocyte sedimentation rate (a.k.a. sed rate): people with active lupus (or other infections) often have high levels
  • Thyroid peroxidase antibodies: presence indicates autoimmune thyroid disease
  • Hepatitis panel and HIV: I'm not entirely sure why she ordered these because I don't have symptoms or risk factors, but whatever...

What she didn't order, but I think she should have are: urine test (presence of protein indicates problems with the kidneys) and Anti-Sm antibody (found almost exclusively in people with lupus; 20 to 40% of people with lupus have it), parasite tests (some of my most recent blood test results could indicate allergic response, autoimmune disease, other illness, or parasites).

What she didn't order, but could have because they wouldn't be a bad idea: anti-histone (sometimes found in people with systemic lupus, but often found in drug-induced lupus), anti-phospholipids (found in approximately 30% of people with lupus).

In case you were wondering where I was getting my data and suggested tests, here are the links to the Lupus Foundation of America and the Johns Hopkins Lupus Center .

Speaking of blood test results, the following things were normal (or at least normal for me) for the tests the original dermatologist did about a week and a half ago: RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, lymphocytes, monocytes, platelet count, ferritin, glucose, free T4, TSH, RPR (syphilis), DHEA. Here's a link to understand what some of the acronyms  stand for.

The following results were abnormal:
  • ANA -- high, speckled and homogeneous patterns present -- 1:160 (expected range < 1:40)
  • White Blood Count -- high -- 13.1 K/UL (expected range: 4.0-11.0)
  • Neutrophils -- low -- 28% (expected range: 40-74)
  • Eosinophils -- high -- 30% (expected range: 0-7)
  • Basophils -- high -- 3% (expected range 0-2)
  • Testosterone -- low -- < 17 NG/DL (expected range 17-76)

  • Obviously, something is going on in my body.  I am anxious to get the results of the tests they drew blood for today, but it will be at least a week or two. The doctor today did also mention one thing that makes good sense. She said if my follow-up blood tests come up negative/normal, it might be a good idea for me to see an immunologist.

    In addition to the wacky immune system results above, I have chronically low Natural Killer cells (not unusual in people with ME/CFS). On a side note, I found an interesting web page with info about NK cell deficiency. I have never heard of this website before, so I have no idea how legitimate it is. Read at your own risk .

    At some point after I get all my results back, I will be seeking a second opinion. I am tempted to see a rheumatologist/immunologist who specializes in lupus and other immune system diseases. That person might be able to sort through all my weird results and help figure out why I'm losing my hair!

    I'm exhausted. Good night!
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