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Rose, when your doctor realized he'd gone too far, were you at least a little amused? Here's my worst (funniest). While I was seeking answers, my husband once accompanied me to a new rheumatologist, who directed 99% of his remarks to hubby. Asked hubby four times whether hubby plays golf (huh?). Smiled beamishly, fluffed hair, tossed head flirtaciously, tapped highly manicured nails, all in hubby's direction, a real performance! Alas, hubby & I didn't think the doctor knew what HE (:eek:) was doing. I barely made it out before collapsing into shrieking laughter. Ever since, when I cross swords with a doctor, I recall that appointment and howl. And when hubby acts up, I threaten to book HIM with this doctor, whom I tagged "Dr. Popinjay" (that's the expurgated version of what I dubbed him :D). Oh, forgot to say that my doctor sported the single worst-looking toupee we'd ever seen, which didn't help either of us maintain a dignified demeanor.

I wonder if having your husband along made your doctor's behavior worse? Couldn't look bad in front of another male, yet didn't have answers yet?

Rereading from your initial post onward, I can sort of appreciate why this may be very difficult to sort out. But I'm just a patient, so please read the rest in that light, OK?

I think psoriasis can elevate ANA, and so can Hashimoto's hypothyroidism (but I don't know how drs. differentiate Hashimoto's from garden-variety hypothyroidism). I think hypothyroidism alone can cause joint pain. While people with lupus have a higher risk of psoriasis (I think), people can have psoriasis without lupus. So I wonder what *doesn't* fit either hypothyroidism or psoriasis? Mouth ulcers & CRP? (I imagine that list would be especially interesting!)

Back to your rashes... Has a dermatologist ever deep-biopsied, to make sure it's psoriasis, not something else? That may sound silly, but lupus creates deposits of immune "junk" between dermal & epidermal layers, which can light up in a line considered diagnostic of lupus, when subjected to special immunofluorescent stains & examined under the microscope. The prodedure is called a lupus band test; and it may be done on lesional or nonlesional skin, on photoexposed or non-photoexposed skin. This LBT test is particularly useful when other labs aren't sufficiently revealing. (I wrote this because there's one lupus-specific rash I've read about that's quite hard to distinguish visually from psoriasis. It's called subacute cutaneous LE, the psoriasiform kind. I had the other SCLE rash, the annular = targetlike form. My suburban doctors knew nothing about the two SCLE rashes, but my metro doctors did.)

Does sun make your rashes better or worse? (I think sun improves psoriasis, whereas UV typically worsens the various lupus rashes.)

What was the order of onset of symptoms? e.g., psoriasis, hypothyroidism, all other symptoms, and all meds you've taken? Were you "off" prior, from childhood? (There I'm thinking of the "sticky post" re: alternative criteria.)

Have your labs been timed at points when your symptoms are "on the rise"? (I was told that in conditions that flare and recede, timing can be critical.)

I hope you can quickly see how Medrol affects your symptoms, and I hope it does. Before you attempt Plaquenil, as another poster wrote earlier, I also think I've read that Plaquenil & psoriasis don't mix well...

In my book, you're doing the right things & should continue in that fashion. All we can do is show & tell, hoping to relate/ask that one tiny thing that helps move tumblers in our doctors' brains! By today I hope you can laugh a little at the ludicrousness. Keep in touch. Meanwhile, all my best, Vee





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