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Wednesday, April 23, 2014
Do I have Lupus?
I am a 51 year old caucasian woman and have been having symptoms fo almost 10 years. Including redness of the face and ears (painful), scaling of the skin on my face (so severe I would not be seen in public), waking in the night with pain in the torso so severe I had to inch my way to turn over in bed, sometimes crying out in pain. However this would go away after a few weeks leaving me exhausted and wanting to do nothing but sleep. Along with a constant vaginal infection which my gynocologist diagnosed as a yeast infection. I have been taking Diflucan weekly to keep this at bay. A constant ear infection with a terrible odor and last but not least chronic fatigue and depression. I have seen my family doctor and a rhuemathologist, along with dermatologists. I have had numerous ANA blood tests done. 5 or 6, each time I was told I tested positive for Lupus and at the same time told I did not have Lupus. Very confusing to me. I was told I had Fibromyalgia. Exercising helps somewhat and have been told to swim also. The ANA bloodwork showed 1 to 80 until last week when it showed 1 to 160. Is this lupus?
This is a very common dilemma faced by the patients as well as by their physicians. Just like your question, I am sure that your physician must have asked himself several times - does this patient have lupus? This shows our limited understanding of this disease. Unfortunately, sometimes it takes a while before the symptoms, exam findings and blood tests become clear enough to make a definitive diagnosis. And, many times several other conditions can mimic this disease. Sometimes, fibromyalgia-like symptoms can be due to lupus. ANA up to 1:80 titer can be normally detected in healthy people. All these scenarios make it difficult to make a diagnosis. Now, what can you do about your condition? At this stage it does not appear that your overall clinical condition `fits` into the diagnosis of lupus. It is, however, useful to regularly follow up with your primary care or your rheumatologist, so that they can pick up any early symptom. While you continue to treat your symptoms of fibromyalgia, you may discuss with your physician about testing for Hepatitis C virus which sometimes can cause lupus-like illness; immunoglobulins to rule out any immune deficiency; evaluation for a condition called `Relapsing Polychondritis` which can give rise to red/swollen/painful ears. You should also assess any risk for HIV or Hepatitis C infection, which are transmitted throgh blood or sexually? And, finally, I hope that you continue to have enough courage to go through your problems with some faith in yourself and your family/friends, and the trust in God.
Ram Raj Singh, MD
Associate Professor of Clinical Medicine
College of Medicine
University of Cincinnati