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    Old 11-09-2016, 08:50 PM   #1
    Sketcher1980
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    Blood results for possible Lupus

    About a month ago I went for a flu shot which led to smalll patches of vasculitus on my hand. This made a rheumatologist want to check to see if I may have Lupus. He ran a bunch of tests and I've posted below the tests that came up abnormal. If anyone has any thoughts on what it may be or what I should ask on my next visit I'd be very grateful.
    From a short conversation I had with him I think he wants to retest after the vasculitus is gone to see if it comes up different and he's hoping if I do have lupus that it only effects the skin.
    I think what concerns me the most is the very low C4 level.
    The cardiolipin levels are not a surpris to me as I've been treating antiphospholipid syndrome for 10 years after having a blood clot.

    RHEUMATOID FACTOR 25 IU/mL
    ANA SCREEN, IFA Positive
    ANA TITER 1:160
    ANA PATTERN 1 Nucleolar
    COMPLEMENT, C3 54 mg/dL
    C4 COMPLEMENT LEVEL 3 mg/dL
    DSDNA ANTIBODY 14 IU/mL
    CARDIOLIPIN IGG ANTIBODY 141 GPL
    CARDIOLIPIN IGM ANTIBODY 74 MPL

    Thanks for any help!

     
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    Old 11-21-2016, 08:40 AM   #2
    VeeJ
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    Re: Blood results for possible Lupus

    Sketcher, without actual references ranges, I can only take a (dumb-patient ) guess at what this all means. That said, I do have some thoughts on some things I'd ask if I were in your shoes.

    ANA. Because it can elevate in many conditions and due to passing viral or bacterial infections, in & of itself, it isn't so valuable. Also, while 1:160 is elevated, I think it's not "wildly" elevated.

    If RF was measured in IU/mL, it perhaps is solidly positive? But since RF can elevate in a variety of conditions, each of which has its own set of diagnostic criteria, you'd want each of those considered. e.g., Rheumatoid Arthritis, SLE, Sjogren's, liver diseases (but you didn't cite any aberrant liver values), sarcoidosis, mono, etc.

    C3 and C4. My best guess is that both are low, which can happen in certain AI's (including lupus), but also in pneumonia, liver conditions (again you didn't cite any liver values), and inherited complement deficiencies.

    Anti-ds-DNA. I'd ask if this was measure in IU/mL. It may be positive, but I'm not sure "how positive". (My lab parses it in 5 ranges, which include "weak positive", "positive", and "strongly positive".) Also, while anti-ds-DNA is strongly suggestive of lupus, I think it can elevate for other reasons as well. In short, the diagnostic criteria are what counts in lupus.

    IGG and IGM. These can definitely depress in lupus, but I'm not sure about other conditions (like RA, for one).

    As to how these thoughts might add up. I'd read at least two sets of diagnostic criteria: for SLE (you may find those in "sticky posts" on the lupus board) and for RA (you could find those elsewhere). And before you read them, you'll want to think about symptoms, too, as both contain symptoms as well as lab results. (Feel free to share your symptoms, as you wish.) Also, are you taking any meds?

    BTW, there are four basic groups of lupus: systemic (in which there ARE circulating autoantibodies), cutaneous (skin, maybe with some constitutional symptoms, but NO circulating AB's), drug-induced, and neonatal.

    Other tests. Was anti-ds-DNA the only "ANA subtype" run? I'd ask whether the whole gamut was run. Examples: anti-Ro (which can point to Sjogren's), anti-RNP (which can point to MCTD), anti-CCP (a test for early Rheumatoid Arthritis), anti-ss-DNA (which can point to drug-induced lupus), and etc.

    I just reread what I wrote above & am not so happy with it, but at least it's a start (hopefully). When is your appointment? Looking forward to updates, Vee

    P.S. Forgot to ask why patch on hand is thought to be vasculitis from flu shot. What does it look like? And is vasculitis from an injection elsewhere even a side effect that's been seen to occur after a flu shot? I guess I'm wondering whether the two might be unrelated, mainly because two things happening in a period of time doesn't necessarily mean "causality" can be inferred.

    Last edited by VeeJ; 11-21-2016 at 08:42 AM. Reason: added SLE to conditions where RF can elevate

     
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    Old 11-21-2016, 08:56 AM   #3
    Sketcher1980
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    Re: Blood results for possible Lupus

    Hi VeeJ, thanks for the reply! I just went to the rheumatologist on Friday so I finally got some updates.

    He said the ANA is low positive but he says the DNA test is a bigger indication that it could possibly be it. He's doing a third test, something with urine that he feels is even more definite. If it does come back positive he would put me on a very minimal dose of Plaquenil as a preventitive because otherwise I have no symptoms. (except maybe a little tired from time to time and occasional joint pain).

    The vasculitus in the hand went away quick enough that he doesnt seem worried and says I most likely have a small problem that affects my skin that wont get worse but my main problem is clotting factors which I've been treating already for 10 years so that doesnt worry me much.

    The reason he's associated the vasculitus with the flu shot was because sometimes according to him the flu shot brings out weird reactions with people with lupus problems. Either way hopefully its gone and I wont have to deal with that again.

    If I find anything else interesting I'll let you know! Thanks!

    Last edited by Sketcher1980; 11-21-2016 at 09:01 AM.

     
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    Old 11-21-2016, 09:48 AM   #4
    VeeJ
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    Re: Blood results for possible Lupus

    Sketcher, it's usual to include urinalysis in the work-up for lupus, even if kidney markers in your blood labs look A-OK. Urinalysis checks for protein and/or sediment in urine, either of which can be seen in SLE nephrotic syndrome. Those findings would constitute meeting one of the 11 criteria, and would also indicate the need for meds stronger than Plaquenil, a closer look at your kidneys, more frequent follow-ups, etc.

    You generally, but not always, must meet 4 or more of the 11. Once met, each is checked permanently, as if checked off in indelible ink.

    Antiphospholipid AB's are a criterion, too, lumped in the one called "immunologic disorders", which is comprised of antiphospholipid ABs, lupus anticoagulant, anti-DNA, anti-Smith, and false-positive syphilis test.)

    Positive ANA, arthritis, kidney disorder (per above, defined as protein or abnormal sediment) are each separate criteria.

    Plaquenil is the drug of choice for milder, meaning non-organ threatening lupus. (It alone isn't adequate if major organs like kidneys, brain, heart, and lungs are affected.) I've taken it for years and it's definitely helped me.

    I'd still want that RA test, though, the anti-CCP, because I *think* anti-ds-DNA can elevate "somewhat" in RA---whereas in lupus, it can range from somewhat elevated to strongly elevated. It would be nice to have RA ruled out, is what I mean. (Some people have both SLE and RA.)

    Lifestyle reco's in lupus typically include avoiding UV exposure because the vast majority of patients are photosensitive. (UV can trigger rashes or overall disease flares.) So you should ask about UV.

    Sounds to me like your rheum is getting closer to formalizing his thoughts. Hope so, and that you continue feeling generally OK (except for that occasional fatigue & joint pain). I take Advil daily, btw, because Plaquenil alone doesn't control my pain adequately. But you'd have to ask about taking OTC's---not everyone can, and I don't know how your already having APS might affect his answer. Keep us posted, and GOOD LUCK!

    Last edited by VeeJ; 11-21-2016 at 09:50 AM. Reason: typo

     
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    Old 11-29-2020, 05:48 AM   #5
    outlawco1960
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    Re: Blood results for possible Lupus

    My blood test looks like that and have dsdna and they still don't confirm i have lupus .... I also have ankylosing spondylitis

     
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