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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35463
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have had chronic widespread joint and muscular since 14

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I have had chronic widespread joint and muscular since 14 years old. Diagnosed hyperthyroidism "graves disease" based on high free t4 high t4 and normal t3 low tsh @ 23yrs old. Progressive pain worsening to muscle spasms in upper back under shoulder blade and hip joint as well as two torn lumbar discs. I'm 33yrs old female white/native american decent. In March this year I had swelling on the left side of my face, chest pain, dizziness, swelling in my feet, hands and wrists, mouth sores, rash on my stomach, and now my hair is falling out. I've had fatigue and pain for 19 years but I've never had this happen. My tests all appear normal c reactive protein is 3.9. My thyroid is normal, kidneys normal, liver normal. Over the years various blood tests all say the same thing everything in normal ranges some things in low normal others in very high normal.
My concern is Lupus. Do you think with my history it is a possibility? The doctors here are not understanding they don't listen. It is like 15 minutes and get out. I'm very worried.

Hello Maria,
I am Dr. Arun and will be helping you today.

Since you have been diagnosed Graves disease which has an autoimmune basis, there is a possibility of another autoimmune disease affecting musculoskeletal system with your history and symptoms. Thus you should be investigated by a rheumatologist or clinical immunologist. The diagnosis of lupus is based on a combination of clinical findings and laboratory evidence. Lupus has following manifestations (any 4 out of these would strongly suspect of Lupus);

1) Oral ulcers
2) Arthritis / Joint pain / joint swelling
3) Issues due to light and sun (Photosensitivity)
4) Abnormal blood test / autoimmune test.
5) Kidney involvement
6) Antinuclear antibodies (ANA)
7) Positive blood tests like dsDNA; anti-Smith [Sm] antibodies
8) Neurological disorder
9) Rashes

You would also need following investigations;

1) ESR or CRP results
2) Complement levels
3) Liver function tests
4) Creatine kinase assay
5) Spot protein/spot creatinine ratio
6) X-ray of the joints

These should be able to ascertain the cause of your symptoms. Lupus may be a small possibility with your manifestations.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

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