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Good Complements?
Aug 31, 2014
Before starting with my questions and concerns about my daughterís condition, I would like to thank all the wonderful people on this board who helped me learn by posting their questions and concerns about lupus. My deep appreciation goes to VeeJ and Ladybud who have been tirelessly helping everybody for so long with their wealth of information and with such kindness.

One month ago my 31 year old daughter developed a sudden onset of multiple joint pains (fingers, wrists, shoulders, knees, and ankles) that was worse in the morning. She felt fatigue on some days but no other symptoms. After a few days (with some relief with a couple of Aleves a day) we saw our PCP. He prescribed Mobic (15 mg/d) for pain and ordered a bunch of tests.
The first set of blood tests included CBC (all normal except slightly low Hgb and Hct), Metabolic panel (all good except slightly high protein), inflammatory markers ( high ESR,69, high CRP,1.8) ANA (high, 1:320, nucleated), TSH (normal), RF (negative), pro time and INR (both normal). Urinalysis result was good except some RBC (5-10 hpf), and few squamos cells. Hand x-ray was normal.

Given the high ESR, CRP, ANA, and mild anemia, the PCP immediately ordered a second set of blood tests which showed high ds-dna (20, normal range 0-4) and normal/negative results for Pro Time, INR, APTT, anti-SS-A, anti-SS-B, anti-Jo-1, anti-Scl-70, anti-CCP, anti-Centromere B, C3, and C4. The third set of tests immediately followed and showed mild iron and vit. D deficiency, positive anti-RNP, slightly prolonged DRVVT (43 sec, normal range 29-40) with borderline (1.2) ratio, and normal/negative results for anti-Sm, anti-SM/RNP, anti-Histone IgG, anti-TPO, TSH, and vitamin B12. Our PCP talked about the results pointing to an autoimmune disease but did not give a specific diagnosis and referred us to a rheumatologist whom we will see in a few days.

Here are my questions and concerns and I would really appreciate it if I can have some feedback. 1) Reading good sources of information on the internet, including this very helpful board, I am almost certain that this must be lupus. Any thoughts on that? 2) Although BUN and creatinine level were good and there was no protein in urine, but with the high level of ds-dna and evidence of hematuria (urine cast not done yet), Iím concerned about kidneys and wonder what should we expect the rheumy to do immediately? 3) Is there any positive value in having good complement levels (C3, C4) in this picture? 5) Most probably the rheumy will prescribe Plaquinil but I wonder if anything else should be prescribed under such circumstances? 6) I see that some rheumys give prescription for prednisone on an as needed basis, but how much and for how long and is this advisable? Sorry for such a long first post! Thank you.





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