My ANA test for three years has come back normal, but I continue to get lesions, my hair falls out, and I get sick easily. I have been to two rheumatologists. Both say I do not have SLE, but my family doctor feels I do. What do you think?

I was also told that because I only have discoid lupus, this would not cause any health problems other than with my skin and hair. So why do I have it in my nose and inside both ears? I’m now 33, my bones are brittle, and I have osteoarthritis in my hands and fingers. Help!

DEAR READER: Whew, where to start? Some children have impaired immune systems, making them subject to numerous disorders. My guess is that you were unfortunate enough to fall into that category.

There are a number of forms of lupus, which is an autoimmune disease. Lupus can affect joints, skin, kidneys, brain, heart, lungs and other parts of the body. Common symptoms include skin rash, kidney problems, arthritis and unexplained fever.

Discoid lupus is a chronic skin disorder that shows as a raised red rash that ordinarily appears on the face and scalp but can appear in other areas of the body, including the nose and ears. The lesions may last for days or years and can recur. Some people diagnosed with discoid lupus may develop systemic lupus erythematosus (SLE) at a later date.

Because arthritis is a common complaint, it’s not at all surprising that you have been diagnosed with fibromyalgia, chronic pain in muscles and ligaments.

Pleurisy is swelling of the lung linings that causes pain and breathlessness during inhalation and exhalation. Causes include acute viral infections, such as influenza, and can be the result of autoimmune disorders, such as lupus.

Kidney stones and related infections have numerous causes, including dehydration, obesity, genetic factors and a diet high in protein/sugar/sodium.

Vertigo can be caused by an inner-ear disorder, migraine headache, acoustic neuroma and other causes.
Depression and anxiety can be caused by lupus, fibromyalgia, kidney stones and vertigo. You have a lot on your plate, and it has obviously resulted in a lot of stress. Osteoarthritis, a breakdown of cartilage, causes pain and stiffness of affected joints. The condition is commonly associated with the aging process, but at 33, you are far from old. Treatment is geared toward controlling pain through medication, rest, exercise and protection of the affected joint(s).

Because so many of your symptoms involve pain, I’m inclined to suggest that you be referred to a pain clinic for control or request a referral to a larger diagnostic center, such as the Mayo Clinic. You will learn methods for reducing the level of pain you presently experience that may include water aerobics and yoga. Appropriate medication might be ordered. Once you get that aspect under control, the anxiety and stress levels you are under may be reduced.

To provide related information, I am sending you a copy of my Health Report “Fibromyalgia.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Yes. Initially, you should request a referral to a rheumatologist. Lupus, a serious inflammatory autoimmune disorder, can affect the joints, kidneys, lungs and several other parts of the body. Many of the symptoms, such as fatigue, joint pain, anxiety, depression and variations in weight, cross over to those of fibromyalgia. Therefore, you should confirm that you do suffer from both conditions.

You should also be under the care of a pulmonologist for control of your chronic cough, asthma and bronchiectasis. The cough could be medication-induced or a result of your asthma. In order to determine what triggers your attacks, it may be necessary for you to undergo testing and to see several other specialists. This may appear daunting but once your textbook complaints of fibromyalgia are better controlled, you will then be able to lift your veil of depression and get on with your life. There is help. The fact that you have written to me is a genuine indication you are ready to get to the bottom of things.

I am only 47 years old and have been healthy my whole life. I need a diagnosis or at least a hint of what could be wrong with me.

DEAR READER:
I urge you make an appointment with a rheumatologist (immune system specialist).

Inflammation of the throat, sinuses, area behind the eyes, and anemia suggest to me you have an autoimmune disorder. These symptoms are common in Wegener’s Granulomatosis, a rare disorder that involves vasculitis (inflammation of the blood vessels). Wegener’s could also explain your Meniere’s type symptoms because ear infections are common and can cause hearing loss, tinnitus, pain, and more. Blood pressure is also affected by vessel inflammation.

I suggest you mention the possibilities of Wegener’s and vasculitis to the specialist, as well as requesting an anti-neutrophil cytoplasmic antibody test (positive in 80-95% of sufferers). Wegener’s may be fatal if left untreated so I urge you to seek medical help.

If I am off base, I apologize. However, based on your symptoms and tests, a rheumatologist is your best bet. You should also be tested further for rheumatoid arthritis, lupus and similar disorders to explain your abnormal rheumatoid factor and Ig antibodies.