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Ask Dr. Brims Your Own Question

Dr. Brims
Dr. Brims, U.S. Licensed Physician
Category: Health
Satisfied Customers: 8792
Experience:  U.S. Licensed Physician, general surgery and internal medicine experience
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Hello, I wonder if you can help. I have been feeling extremely

Resolved Question:

Hello, I wonder if you can help. I have been feeling extremely fatigued (can only function 2-3 hours a day) and am suffering with joint pain over the last 4-5 years and this has worsed significantly recently. My blood test results from 3rd June 2013 show elevated ESR (23) and elevated Serum Complement C4 (0.71) and ANF screen is positive. C3 complement is just on the border of being elevated at 1.65. Lupus and Rheumatoid Arthritis are showing as negative. Please can you tell me what could be causing my joint pain (knee pain has been particularly bad with swelling this week) if Lupus and RA are showing negative? My face (nose and cheeks) went extremely red (like a butterfly rash) 2 weeks ago when I was outdoors (18 degrees) and this lasted for 2-3 days, however as stated above Lupus Anti coag screen is negative in my blood test. I would be grateful for any advice as to how to cope as I am starting full time work next week and am worried I will not be able to work a full day due to exhaustion and low grade fevers. Thank you, XXXXX XXXXX Barmi.
Submitted: 10 months ago.
Category: Health
Expert:  Dr. Brims replied 10 months ago.

Dr Brims :

Hello, welcome to the site! My name isXXXXX and I will try to assist you with your medical question, and any medical information you seek

Dr Brims :

I'm sorry to hear about this condition

Dr Brims :

Do you have any other tests like a C reactive protein?

Customer:

Hello Dr Brims

Dr Brims :

Hello

Customer:

I do not understand C Reactive protein.I have only had the following tests:

Customer:

ANF screen - positive

Customer:

RA IGM EIA - 0

Customer:

Anticardiolipin IgG 2.8777

Customer:

Anticardiolipin IgM 1.366

Customer:

Anti DNA (ds DNA Abs) 4

Customer:

CBC tests - all within normal range

Customer:

Serum Complement C3 - 1.65

Customer:

Serum Complement C4 - 0.71

Customer:

C reactive protein - 4

Customer:

Ah yes there it is!

Customer:

It was within normal range

Customer:

ESR - 23 (elevated)

Dr Brims :

Okay, there are still some other tests you should have to rule out lupus

Dr Brims :

Sorry continue if there are more tests

Dr Brims :

Are you there?

Customer:

Lupus anti coag tests all within normal range

Customer:

I have an underactive thyroid for which i have medication

Customer:

thyroid function test normal

Customer:

thats all the tests

Dr Brims :

Ok

Dr Brims :

any other tests?

Customer:

no

Dr Brims :

Okay, I would advise you have anti Smith antibodies checked, which would be found in patients with lupus, and Anti-nRNP which may be found in lupus or mixed connective tissue disease

Dr Brims :

Either of the above conditions are still possible

Dr Brims :

Mixed connective tissue disease can also cause the symptoms you have

Dr Brims :

Are you there?

Customer:

May I ask what is mixed tissue disease please?

Customer:

I am here

Dr Brims :

It is an auto-immune disease that causes joint swelling and fatigue

Dr Brims :

It is similar to lupus but not as severe

Customer:

Is there a cure?

Customer:

Would this be the cause of the red rash on my face which occurred following exposure to the sun?

Dr Brims :

There is no cure, but it may be treated successfully and controlled

Dr Brims :

It could be the cause, but it could also still be lupus, the tests you have done do not rule out lupus

Customer:

Ah right, so it is inconclusive until I have further tests done?

Dr Brims :

Yes, that is correct

Customer:

Sure okay

Customer:

Thank you

Dr Brims :

You're quite welcome

Dr Brims :

If you still have questions on this topic please feel free to ask

Customer:

What does positive ANF mean please?

Dr Brims :

Anti nuclear factor

Dr Brims :

It means you have antibodies in your cells attacking your own cells

Customer:

and what causes this?

Customer:

Also, can this lead to cancer?

Dr Brims :

The cause is unknown, but it does not lead to cancer

Customer:

If I continue to exercise will this worsen my condition as joint pain is severe (especially in knees and ankles) when I exercise

Dr Brims :

It may worsen your condition, you should have it x rayed to determine how sever the joint damage is

Dr Brims :

If the damage in your joints is severe, you may have to limit exercise

Customer:

Okay I will avoid exercise impacting my joints

Dr Brims :

That is reasonable

Customer:

If the condition worsens, how likely is it I will end up in a wheelchair in say 20-30 years?

Dr Brims :

That is not possible for me to predict at this stage

Customer:

Also, what can I do to stop the shooting pains in my body, I have taken painkillers which do do not work

Customer:

I have pain even now in my legs

Dr Brims :

You may need stronger medication like celebrex or higher doses of ibuprofen

Customer:

I have been taking 400mg (x2 tablets) a few times a day to no avail

Customer:

I will ask for more medication from my GP

Dr Brims :

I see, then you may need a drug like celebrex or oxycodone

Customer:

When I was 22 I was diagnosed with Rheumatoid arthritis, I am 26 now and RA came back as 0 in my blood test

Customer:

does that mean the cause of my swollen knees is not RA?

Customer:

sorry i am now 36*

Dr Brims :

It means it is not likely RA

Customer:

Is RA a symptom of lupus or mixed connective tissue disease?

Dr Brims :

No, it is a different condition

Dr Brims :

It is also an auto-immune condition

Customer:

Ah right okay

Customer:

Well you have been most helpful, I will wait until I have had further tests done as recommended by you

Dr Brims :

You're quite welcome

Dr Brims :

If you have questions in the future, you may request me by starting the question with "Dr Brims"

Customer:

Will do, thank you again, enjoy the rest of your evening.

Dr Brims :

You're welcome

Dr Brims :

If you have no other questions on this topic, you may click a rating button to exit the chat session

Customer:

Fabulous, will do that now.

Dr. Brims, U.S. Licensed Physician
Category: Health
Satisfied Customers: 8792
Experience: U.S. Licensed Physician, general surgery and internal medicine experience
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