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Wednesday, December 4, 2013
SEVEN YEARS AND STILL NO ANSWERS
I have had severe fatigue, weakness, frequent shortness of breath, achiness and a host of other strange symptoms for seven years (which began during the last trimester of my third pregnancy). I was prescribed at least eight or so different antidepressents over the years, none of which helped. I had a sleep study done in 1997 which did not show apnea or narcolepsy and was NOT suggestive of depression. I saw a psychologist who did not believe that I was suffering from depression. I had a brain MRI which ruled out MS. Recently, it was suggested that I might have myasthenia gravis and was sent to a neurologist. Although a specific blood test for that was negative, he still prescribed Mestinon. I feel improvement, but not cured. He then wanted to go back to trying antidepressents again, which I just don`t see the point in anymore. I had a ANA which was 1:320, but the neurologist told me not to worry about it because I am hypothyroid and it was from that. Not one time has anyone suggested lupus and I am wondering why. Also, I have had a recurring ringworm rash for about a year. I currently have a quarter-shaped rash on my palm (on the meaty part below the thumb) which has been there about 4-5 months, but I have not bothered to show anyone that because it seems insignificant. This fatigue and weakness have SIGNIFICANTLY altered my life. Should I specifically ask to be evaluated for lupus and what would that evaluation include?
Our current knowledge of lupus is still quite limited, and the diagnosis is generally based on the presence of a set of symptoms and physical examination findings. In our practice we have several patients who have such a high level of positive ANA test, yet we do not have a definite diagnosis. When followed for a long time, many patients do not develop any additional problems, while other patients develop other symptoms and signs that suggest the presence of lupus or other connective tissue disease. Most physicians reserve the diagnosis of lupus to patients who fulfill the absolute criteria of lupus; this approach avoids unnecessary treatments that by themselves may cause adverse effects. ANA is a relatively NON-specific test that can be present in several disease states and can even be induced by certain medications such as hydralazine, procainamide, minocycline, among others.
In your situation, it might be worthwhile for your rheumatologist to consider additional tests such as anti-Ro (also called anti-SSA), complements, total IgG, ESR and routine urinalysis. Again, your physician would be best judge to consider these tests as the clinical judgement, rather than the tests, would best solve the problem.
Ram Raj Singh, MD
Associate Professor of Clinical Medicine
College of Medicine
University of Cincinnati