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Blood work
May 23, 2015
Latest blood work

Anti-nuclear 1:640 speckled
C3 73 mg/dl Should be 88-165
C4 12 mg/dl. Should be. 14-44
Cl-mmol/l 111 Should be 96-107
SSB antibody 721 au/ml. Greater then 100 is positive
SSA antibody 626 au/ml. Greater then 100 is positive


What are your thoughts on this so far? Really feeling worn out and hurting as of late. Like my doctor but she never goes over the results of the blood work with me so it leaves me scratching my head, lol. I would be greatful for any input. Thanks again!
Re: Blood work
Jun 2, 2015
[QUOTE=VeeJ;5364068]Hi. I'm merely a patient, so please read in that light. First, a quick question: is your doctor a rheumatologist? If NO, I'd want one, for the reasons below. If YES, I'd try a new rheum.

First, I believe that at least two of your labs, elevated ANA and depressed serum complements C3 & C4, are both cited in the 11 diagnostic/classification criteria for [B]SLE[/B]. You can read all 11 in one of the "sticky posts" located above the user threads. A patient generally, but not always, must meet 4 or more of the 11 to sustain a dx of SLE. The criteria may be met serially over time, meaning not necessarily simultaneously: envision checking each, once met, in indelible ink.

In your shoes, I'd also wonder whether I'd met any *other* SLE criteria. For example, what about protein or sediment in urine, as found by urinalysis: has urinalysis been done regularly? And etc.? Not meant to scare you, only to stress that ALL criteria need to be vetted. So as you read through the 11 criteria, you should question which have been tested for, or queried.

Re your positive ANA subtypes, anti-Ro and anti-La. Yes, these can elevate in [B]SLE[/B], in a small-ish subset of patients. Meaning, you can have SLE with ONLY anti-Ro or both elevated. One criteria cites anti-ds-DNA and anti-Sm, but you can have lupus without these two. (I do. I was positive only for anti-Ro. My dx was confirmed by a lupus band test done by a dermatopathologist, which confirmed that my recurrent photosensitive skin lesions were a lupus-specific rash. I'd had various other symptoms and labs, over many years.)

BUT, those two AB's, anti-Ro and anti-La, are ALSO seen in [B]Sjogren's syndrome[/B]. Sjogren's has its own set of diagnostic criteria, which you could find elsewhere. (There are several excellent library books that cover lupus, Sjogren's, and all "close cousins".) FYI, the most definitive test for Sjogren's is lip biopsy (it looks for an inflammatory infiltrate). But there are lesser tests, too: Schirmer's (it measures tear production) and Rose-Bengal staining or lissamine green staining (those look for corneal pitting and scarring).

What I don't know, and only a proper rheumatologist could say, is whether your labs and symptoms so far tilt to one or the other, lupus or Sjogren's, and whether you've met the diagnostic criteria for either. So my best thought is that you need a doctor who WILL discuss & explain your labs, review your symptoms ongoing, present you with a shortlist of possible candidates, then follow through to answers, likely meaning more tests. You may need to PUSH to make this happen, which I absolutely encourage you to do!

I'm not sure what test you mean by "Cl-mmol". Chloride?

Anyhow... we're here whenever you want to talk. And I hope others chip in, too, because many of us have experienced diagnostic gridlock. We'll look forward to your next post. Meantime, sending you warm wishes, sincerely, Vee[/QUOTE]



Thank you for your replay. The doctor I'm seeing is a rheumatologist but at this time I can't say I'm happy with her. I had a MRI done last week on my knee and she couldn't contact me with the results. I finally emailed her today to find out the bones around my knee are starting to break down.

I know I have both lupus and sjogrens among many other auto immune issues. I am just getting frustrated at her lack of explaining test results. I feel like I don't know how things are going anymore. I do know how I've been feeling as of late and it's not good.

Thank you again for your help
Re: Blood work
Jun 2, 2015
Hi, again. I'm really sorry to read about your knee MRI results. Her [your rheum] not explaining lab & test results isn't what you want communication-wise, but does she at least have you on meds? (Just asking that makes me very nervous, as I couldn't tell from what you wrote so far.)

Re lab results, my rheum requires his patients to call in for results, then he speaks to you in person only if there's anything remarkable, otherwise his secretary tells you that all came back OK. He has a "system", is my point, that ensures results get communicated, with the patient also playing her role by calling. If your rheum has no "system", or if you take it upon yourself to call but you get no answers, I'd be uncomfortable, too, and very angry!

For your knee, has anyone referred you to an orthopedist?

I hope you either smooth things out with your current rheum or find a new one with whom you can establish MEANINGFUL 2-way communication. Please let us know how you're doing & what happens. Thinking of you, Vee





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