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Hi, ta2d, and welcome! Obviously I'm merely a patient, so please take everything that follows in that light.

Like you, I've never heard of a malar rash due to RA. I have heard, though, of RF sometimes being positive in lupus-only patients. Also, I've read about a *crossover* called "rhupus", featuring aspects of both RA & SLE.

The only sure way I know of to determine whether a rash is a lupus rash is via skin biopsy coupled with immunofluorescent stain tests. (The stain tests light up in lines that are characteristic to lupus, which is why they're considered so valuable a tool.) I had these tests done by a dermatopathologist, but I'd guess a dermatologist could also call for them to be done by an outside lab. (But I assume a positive on the skin tests would prove lupus without disproving RA...)

Dr. Wallace writes about distinguishing RA from SLE with X-rays when lab tests come out suggesting either/or: "mouse bites" can show up on X-rays in RA. But whether RA *always* produces mouse bites, I don't know, especially early on in the disease or where a patient has taken meds to forestall same. (And I assume mouse bites would suggest RA without disproving lupus.)

At the time of initial Dx, did your rheumie find any specific autoantibodies other than RF, like anti-ds-DNA, anti-Sm, anti-Ro, anti-La, etc.? Dr. Wallace lists 16 such things seen in lupus, with varying degrees of specificity. Anti-ds-DNA & anti-Sm are the only two on the long list considered specific to SLE; the others, less so, and to varying degrees.) Your rheumie could call for these more *specific* autoantibody tests at the same time he orders a new ANA. Unfortunately, I think some of these substances can wax & wane with flares, and/or due to meds as well...

While csome treatment for RA and SLE can overlap---the meds you've taken may be utterly appropriate for both---I can sure see why you'd want to know which you have, or whether you have aspects of both! Minimally, there'd be varying problems to be on the lookout for, I think.

Dr. Daniel Wallace covers all the above---and much more---in his excellent hardcover, which is in most libraries & larger bookstores. I think the 3rd edition is the most current. The index at the end can help you zone in quickly. I hope you can get clarity soon. Let us know how you're doing, OK? Sending warm wishes to you, Vee

P.S. It's actually possible to have SLE without a positive ANA. But so-called "Ro-lupus" requires the "anti-Ro" autoantibody & also meeting the usual # of ACR diagnostic criteria. It's very rare, which I learned the hard way, by living it. (A prolonged, confusing MESS!) People with Ro-lupus are actually "eligible" for malar rashes, but far more often they have only SCLE psoriasiform or SCLE annular as their rash type.





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