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jay2penny, hi. Welcome! First, congratulations on your new baby girl.

In answer to your question, my doctors (many) didn't diagnose lupus or prescribe lupus meds until they were totally sure*, because they didn't want to modify or flat-out suppress my immune system without proof. (* For me, totally sure meant meeting > 4 lupus diagnostic criteria. You may find those in one of the "sticky posts" = permanent info posts that are located right above the user threads. Also, I had three Lupus Band tests done. The LBT is a deep-punch skin biopsy that includes immunofluorescent stain tests. The LBT looks for circulating "immune junk" that's been depositied between dermal/epidermal layers, an abnormal deposition that occurs virtually exclusively in lupus.)

Here are some things I learned along the way that makes a cautious approach make sense---well, to me, anyway---even though I very much agree that it's horribly stressful not knowing what's going on. First, ANA elevates in multiple conditions within rheumatology, but in other "o-logies" too (endocrinology, gastroenterology, hematology, oncology, etc.). Also it can elevate due just to a passing virus or bacterial infection. Also merely due to a family tendency.

ESR is an inflammation marker, but like ANA, it's non-specific.

And rashes and hivelike itchiness occur in conditions other than lupus that *might* be on the table for you. I'm only a patient (obviously!), but I believe that hypothryoidism can can some of what you mention, including itchy rashes, pain, sluggishness, etc. To illustrate, my sister & I shared quite a few (not all) symptoms; her dx was Hashimoto's thyroiditis, mine was lupus.

Mouth ulcerations are definitely possible in lupus: they're actually one of the diagnostic criteria. But they can happen for other reasons, too.

Of the 11 lupus criteria, I believe the ones that scream lupus the loudest are anti-ds-DNA and anti-Sm, as both are seen virtually ONLY in lupus. The malar rash is a strong sign, too, but it's hard to distinguish from rosacea, even by experts. That means all the others are "softer" or "fuzzier" [my terminology]. That's another reason doctors don't jump to the diagnosis: lacking any "biggie criteria" [again, my term], they're compelled to be cautious.

re: your blood labs. I compared yours to my last set, but different labs use different ranges, I think. Anyway... ANA of 1:320 would be considered elevated by any lab, I think. Ditto with your ESR. But my lab would not consider your RBC low---did yours?

I hope others add more & that you keep posting. We're good company (if I do say so myself :D), and there's a lot of experience that includes lupus & all its close cousins, also co-morbid conditions (thryoid & the like). I'll say bye for now, with my best wishes, sincerely, Vee

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