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Please tell me what you think. Also if you have a recommendation of a Rheumatologist in the Dallas, TX area please let me know.

Facial nodules of varying sizes, mostly circular in shape accompanied by joint pain. JP limited to mostly, elbows, fingers, knees and shoulders (in that order). Occasionaly fever (low grade) and headache. JP often accompanied with red areas on or adjacent to the joint.

Also nodules now on shoulders and upper back. All nodules are firm and tender to touch. Usually last about a week.

Test # 1 by Primary Care (referred me to a rheumatologist).
ANA=positive w/ homogenous(smooth) pattern
Titer=1:1280
Platelets=high 423 on a scale of 140-415
RA Latex Turbid=high 15.5 on a scale of 0-13.9
C-Reactive Protein=High 20.9 on a scale of 0-4.9
Polys (absolute)=low 36 on a scale of 40-74
Lymphs (absolute)=high 57 on a scale of 14-46
Sed Rate=high 30 on a scale of 0-20
TSH H 7.083 on a scale of .35-5.5 (this has bounced around from the beginning of my thyroid issue (1995) and the endo blows it off as drug potency differences

Tests by Rheumatologist
Sed rate=high 43 on a scale of 0-20
Specific Gravity (urinalysis)=low 1.005 on scale of 1.005-1.035
The following were negative (1st letter cut off of lab sheet):
ssa .7 <16 considered negative
?SB .9 <16 considered negative
?M/rnp 1.8 <16 considered negative
?sDNA single point 5 <25 considered negative
SM? 1.9 <16 considered negative

ANA Elisa Screen 5.36 Positive is >1.09
C-reactive Protein Normal .8 on a scale of 0-.8
C3 normal
C4 High 50.6 on a scale of 16-47
RA Factor High 21.6 on scale of 0.0-20.0
Cyroglobulin=none detected after 72 hours
Anticardiolipin tests both normal
Angiotension Converting enzyme=normal

Bioposy of nodules by Dermatologist (because rheumatologist office not equiped for that test (is that normal)) on upper left back="Though not unequivocally diagnostic, showed no changes due to SLE or Sweet's Disease. These findings could be those of a hypersensivity phenomenon that may be drug induced."

Current medications:
Armour Thyroid alternating 90mg/120mg (recently began this cycle, prior to that 90mg daily)
aspirin(325mg)
Triphasil (birth control for irregular cycles)

Diagnosed with Sleep apnea May 2003.

Not sure if it is related, but my latest nodule episode has lasted longer than a week with new nodules appearring as the older ones fade. (seems to correspond with increased thyroid meds). Endo suggested that I wait before seeing a rheumatologist (I didn't follow that advice) and am seriously contemplating changing endo's.

Had been going on since april/may of 2003. No decrease in frequency, but seems to be increasing in frequency.


Blood work 2 weeks apart.
Hi seatx,

First off, my initial reaction after reading your bloodwork was "ooohhhh" and I quote. Secondly- DITCH that Endocrinologist if you can. It doesn't sound like he is operating in your best interest. What the heck is the Rheumatologist doing with you? They certainly can't just let you go with SO many abnormalities in your blood work. I must tell you that your ANA is VERY high, meaning that there is a LOT of disease activity showing right now. You MUST be careful and be seen because you could get very sick very quickly with the blood work that you posted. I am going to go through each test to tell you what they mean okay?

ANA=positive w/ homogenous(smooth) pattern
Titer=1:1280 [B]THIS is VERY high.. and the pattern means Lupus.[/B]
Platelets=high 423 on a scale of 140-415[B] Since this is a bit on the high side, I would worry about bleeding in your body somewhere or a bone marrow abnormality[/B]
RA Latex Turbid=high 15.5 on a scale of 0-13.9[B] I believe this is one of the tests for Rheumatoid Arthritis (which would explain your nodules) but don't quote me on that! I am pretty sure it is though[/B]
C-Reactive Protein=High 20.9 on a scale of 0-4.9[B] This indicates that you have extreme inflammation OR infection going on in your body. It is a non-specific marker for infection and inflammation. Usually with Lupus the CRP is very low UNLESS you have an active infection. It's worth getting checked out that's for sure![/B]
Polys (absolute)=low 36 on a scale of 40-74 [B]another indicator that your body is fighting something off[/B]
Lymphs (absolute)=high 57 on a scale of 14-46[B] This indicates that your immune system is kicking its own BUTT!![/B]
Sed Rate=high 30 on a scale of 0-20 [B]This is an indicator for non specific inflammation, which you have.[/B]
TSH H 7.083 on a scale of .35-5.5 [B]You probably know what this means with your thyroid! [/B]

Rheumy's tests
Sed rate=high 43 on a scale of 0-20[B]same as above, your inflammation is worse now :( [/B]
Specific Gravity (urinalysis)=low 1.005 on scale of 1.005-1.035 [B]Not too concerning since its borderline[/B]
The following were negative (1st letter cut off of lab sheet):
[B]Anti-RO[/B] SSA: .7 <16 considered negative [B]This is an indicator for Sjogren's Syndrome (dry eye's etc) [/B]
[B]Anti-LA: SSB[/B] .9 <16 considered negative [B]This is an indicator for other components to Lupus[/B]
[B]Anti-RNP[/B] 1.8 <16 considered negative [/B]Same as above[B]
[B]Anti-Double stranded DNA[/B]:single point 5 <25 considered negative [B]another Lupus test
[B]Anti-SM[/B] 1.9 <16 [B]considered negative[/B]

ANA Elisa Screen 5.36 Positive is >1.09 [B] Same ANA test as above, just different lab values[/B]
C-reactive Protein Normal .8 on a scale of 0-.8 [B] This means that your CRP has come down[/B]
C3 normal [B] This is a lupus test too[/B]
C4 High 50.6 on a scale of 16-47 [B] I am looking into this one, I know with Lupus both C3 and/or C4 being LOW indicate active disease[/B]
RA Factor High 21.6 on scale of 0.0-20.0 [B] This indicates Rheumatoid Arthritis but can also go with Lupus! 30-40% of people with Lupus have a positive RA[/B]
Cyroglobulin=none detected after 72 hours
Anticardiolipin tests both normal
Angiotension Converting enzyme=normal


Different people have different antibodies, and that is why the Rheumatologist tested you for all of those above. They don't rule out Lupus, because you have the ANA VERY positive with a suggestive pattern for Lupus. My concern is that you have an "overlap syndrome" going on here.. what they call it is Mixed Connective Tissue Disease, meaning you have a few different conditions going on here. This is just crazy, why aren't they treating you?

I spent lots of time researching all of this for you, and I have come up with LUPUS being a culprit and a possible overlap with RHEUMATOID ARTHRITIS.

Could you list your symptoms other than the ones that you have currently? I would be thrilled if you could post some of your health history also, like if you have had kidney infections, lung inflammation, etc Anything in your past that is relevant. I would suggest getting back to your GP and getting referred to a Rheumatologist that deals with LUPUS patients. What did that last Rheumy say to you? I hope that this helps!! Talk to you soon :)

~Angelic





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