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Cari, personally I woudln't start [B][U]Vitamin D[/U][/B] until my drs OK it; aslo specify which form, how much & how often. I think this way because
1. You want them to see you "as is", at your natural Vit D level.
2. Taking too much Vit D is definitely dangerous. Plus, I don't know if supplementing is safe for everyone: there may be exceptions?

[U][B]Hyperparathyroidism[/B][/U]. I don't know if "secondary hyperparathyroidism" is possible with elevated PTH coupled with normal serum calcium. All this body chemistry is new to me & over my head, to be honest. But I think there are U.S. hospitals that specialize in parathyroid disorders. Have you tried finding & reaching out to them? (The interesting thought here is that "secondary" parathyroidism would be the result of some "primary" process... and wouldn't you LOVE to know what that is?)

[U][B]Fibromyalgia[/B][/U]. I've never read that fibro can elevate CRP and ESR. I've always pictured it as a pain syndrome that lacks those very features. I hope others chip in on this.

[B][U]Rheumatoid Arthritis[/U][/B]. I think it has its own diagnostic criteria that may not even "require" elevated RF, so you could look into those. (Unfortunately there are > 100 forms of arthritis.)

[B][U]Lupus[/U][/B]. Those 11 criteria in the "sticky" are used to diagnose and classify systemic lupus. You generally (not always) have to meet 4 or more to sustain a Dx of systemic lupus. They may be met cumulatively, over time: envision checking each off in indelible ink, once met. There are people who meet < 4 but who have SLE confirmed, but that's typically thru kidney biopsy, which I'm guessing is done only where BUN, Creatinine, and GFR abnormalities exist. Lupus nephritis correlates heavily to anti-ds-DNA, which is probably why your lung specialist tested for that AB right off the bat.

ANA is a criteria for SLE, but it's what I call "fuzzy" because it can elevate in so many conditions, not just lupus; plus it can elevate for reasons not having to do with chronic disease (like virus, infection, or a family tendency). 1:40 will likely be viewed as only very slightly positive, is my guess. But is it possible to have systemic lupus without a positive ANA? Yes, but only very rarely: 3-5% of people with systemic lupus remain ANA-negative, but these people do test positive for the anti-Ro subtype. This rare subset of SLE is sometimes called "Ro-lupus".

In addition to "systemic" lupus, there are other subsets. In DLE (discoid LE), sometimes called skin-only, people may meet only 1 or 2 criteria and don't have circulating antibodies. You'd need discoid lesions to fall into this group; and if your skin lesions don't scar &/or depigment, I'm guessing it's unlikely they're discoid lesions.

In the SCLE subset, people may meet less than 4, 4, or more than 4 criteria. ANA is positive in roughly 2/3. Rashes associated with this subset are the two SCLE rashes that are described in the "sticky" on rashes. Most in this subgroup (not all) are positive for anti-Ro.

In the DILE (drug-induced) subset, people meet 1 or more criteria, plus are most often (not always) positive for anti-ss-DNA (that's single-stranded, not double) and for anti-histone. Treatment consists of identifying the culprit med(or meds) & discontinuing. You could ask if your med(s) have ever been implicated in DILE; if YES, maybe he'd test for anti-ss-DNA and anti-histone.

[B][U]Skin[/U][/B]. I don't know if the sun reaction you describe fits any of the lupus-specific rashes. I think there are many photosensitive rashes & reactions that aren't lupus-related. Another thought: some meds don't mix with UV. Did you check your meds to see if any preclude being in the sun?

[B][U]Thyroid[/U][/B]. Even though scans showed your thyroid looked normal, what about serum values? Hashimoto's thyroiditis can elevate ANA & cause joint pain hair loss, body temp changes, etc.

But I'm just a patient, so please take all I write in that context. But one thing I can recommend without reservation: before seeing your rheum this week, really, really study those stickies, as they'll explain what your rheum would likely need to see before he puts lupus (in some form) on the "maybe" list. You must be horribly frustrated, so I hope this ANA finding leads to some new thinking. Then if lupus or some other AI isn't suspected, maybe some odd infection, virus, parasite, Lyme, etc.? Stay in touch, OK? Thinking of you, Vee

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