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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35511
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I previously had 1:160 ANA homogenous and speckled. Another

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I previously had 1:160 ANA homogenous and speckled. Another test had 1:160. Another had 1:80 and now this one 1:80 homogenous and speckled. Dx for lupus and at the time it made sense, but symptoms are much less now although alcohol intake decreased, stopped smoking, left my stressful relationship, so life changes factor into my well being of course. I do have red swollen joints. Just can't really figure it ouf
Submitted: 2 years ago.
Category: Health
Customer: replied 2 years ago.
I'm just wondering an alternate dx. Obviously I have something going on. Pain, headaches, sometimes severe fatigue, anxiety, swollen painful joints, etc. all of these symptoms were far worse previously.
Customer: replied 2 years ago.
Brain scan ruled out ms.At this time, I am not being treated due to "go to neurologist" "go to endocrinologist" (tpo high and history of hashimotos and graves disease) "go to rheumy" etc. back and forth, then gp unable to treat me for anything. Became exhausting and extremely expensive for years of this. Doctors couldn't get on same page. Even with lupus and thyroid disease dx, no treatment as I suppose disease not progressed enough? No management. Offered cymbalta, have concerns about that. Thyroid testing and cortisol etc testing completed. Only medication offered was metformin as thyroid still functioning.
Expert:  Dr. Arun Phophalia replied 2 years ago.
I am Dr. Arun and will be helping you today.
I am sorry that your question was unanswered for long.
If a patient has a positive test for ANA, depending on the symptoms or findings on physical examination, additional tests are ordered to identify specific types of autoantibodies.
If a diagnosis of SLE is suspected, then additional tests, looking for autoantibodies directed against double-stranded DNA, Sm antigens, and ribosomal P antigens may be ordered. Because these antibodies are relatively specific for SLE, the results may provide important clues to facilitate the diagnosis of SLE. I hope you have been completely investigated on these lines.
Lupus or other autoimmune disorder like Hashimoto thyrooiditis are spectrum of diseases. While the medical literature do classify the various disease process and the diseases, there are many overlaps and when we study an individual, this classification may get blurred and intermingle.
Your physician looks after your symptoms, ascertain the signs, investigate you and with your past history, personal habits, family & medical history, would try to label you with a diagnosis and then institute the treatment. Quite a complicated phenomenon and never work by logic and inferences. There would be always two opinion on an individual's diagnosis. And since it does not work by logic, many times work by sheer experience; this is the reason they have not been able to make a computer program to give the correct diagnosis.
I fully agree with you. This is a tough situation and in the absence of a concrete diagnosis and treatment, and with persistent annoying symptoms you are at the loss. Now let me explain other common problem encountered; we as a clinician come across. We are may times unable to pinpoint a diagnosis. But usually we are able to point the pathological process. This can be allergic, immunological, infective (viral /bacterial/fungal), parasitic, neoplastic, genetic, congenital etc. Once we are able to identify the pathological process, we can start the treatment. May be in your problem, the diagnosis may not be pin point according to the textbooks but it is likely to be either immunological and hormonal. The treatment protocol for these can be started.
There is another issue which I see. There may be a concomitant issue with the autoimmune phenomenon. This makes the clinical picture slightly confusing so your doctor may be reluctant to start specific medications for Lupus. You may consider consulting a rheumatologist working in an hospital attached to a medical school. They are academic oriented and may be able to give you a concrete diagnosis and treatment.
Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
Thanks for using Just Answer.
Expert:  Dr. Arun Phophalia replied 2 years ago.
Please let me know if you have further queries or unanswered questions.
Please consider a positive rating if this interaction has been satisfactory, as this is the only way we experts are credited and compensated for the time and work.
Thank you.
Wishing you all the very best in life.
Expert:  Dr. Arun Phophalia replied 2 years ago.
It is good that you have made significant life style changes which has helped you. For your present manifestations of pain, headaches, severe fatigue, anxiety, swollen painful joints, etc. following may be tried, meanwhile you are investigated;
1) Aerobic exercise; low-impact aerobics, walking, water aerobics, stationary bicycle.
2) Heat, massage, and other treatments like sauna, hot baths and showers, hot mud, and massage.
3) Trigger-point injections,
4) Acupuncture,
5) Chiropractic manipulation,
6) Myofascial release
7) Neural pulse stimulation (CNP) device
8) Cognitive-behavioral therapy (CBT) and operant-behavioral therapy (OBT)
9) Relaxation training and biofeedback
10) Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen
11) Local analgesic creams
12) Anxiolytics/hypnotics
13) Estrogen receptor modulator raloxifene
14) St. John's wort, ginseng, valerian, botanical oil, melatonin, magnesium, dehydroepiandrosterone.
Your doctor may have not prescribed you a specific treatment when he/she may be considering diagnosis like fibromyalgia. Fibromyalgia is a chronic condition, which may have following of the manifestations;
1) widespread muscle pain, "myalgia,"
2) excessive tenderness in many areas of the body
3) fatigue,
4) sleep disturbances,
5) headaches,
6) mood disturbances, such as depression and anxiety.
Hoping a positive rating.