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Forum Name: Rheumatology Topics

Question: Hx of lyme disease, positive ANA


 tiredgirl - Sat May 23, 2009 10:49 pm

I was diagnosed in 1998 with Lyme disease. I was treated with 30 days of Cephalosporin and about 1-2 months later I could walk up stairs without stopping to rest again. I feel like I have had fatigue since the late 1990's which i always attributed to my depression or antidepressant that i was taking at the time. I take Lexapro now and my depression is very mild and nothing like what I was experiencing from ages 16-21. In 2007 I had a liver function test due to being on Elmiron for 3 years to treat Interstitial Cystitis. My enzymes were slightly elevated so I was sent for a hepatic panel which showed a smooth muscle antibody of 38 and an ANA of 1:40. My liver enzymes were normal from then on. A repeat test showed my sm antibody to be normal and my ANA still at 1:40. In May of 2009 I had an ANA checked d/t ruling out Shogren's or Lupus or auto immune disorder while trying to find the cause of chronic mouth ulcers. The ANA was negative on May 4, 2009. I asked my primary doctor to recheck my sm antibody, and ana and he also checked ss-a and ss-b and double stranded dna on May 12, 2009. My sma was 19. My ANA was 1:320 homogenous. All other labs negative. I have had a rash across my nose and cheeks for a few years which is the pattern of the malar rash and not painful, itchy or bumpy. I feel like I have something going on. The plan is to recheck my ANA in 3 months. Is there anything else we should be checking? Do I need to see a Rheumatologist? Right now fatigue and mouth ulcers are my only complaint. Any suggestions would be greatly appreciated.
 Tom Plamondon PA-C - Mon Jun 08, 2009 6:34 am

User avatar Hello,
The ANA of 1:40 is essentially normal however the 1:320 result suggests lupus especially with the facial rash, mouth ulcers and fatigue. Any symptoms of arthritis?

Anti smith and anti ds antibodies are the next steps.

A referral to an endocrinologist is reasonable especially since you have met some of the criteria for lupus and will need some follow up testing and treatment as indicated.

Take care and let us know how it goes.
 tiredgirl - Tue Jun 09, 2009 8:20 am

Hi, I have never had an issue with joint pain or arthritis. My right knee give me trouble sometimes d/t having a torn meniscus that has been repaired but is believed to be torn again. I had the anti smooth muscle test and anti double stranded dna test the same time i had the ana. The anti smooth muscle was 19 but it came back in 07 as 38. The anti ds dna was normal. Thank you for the suggestion about the endocrinologist. I was thinking rheumatology only.

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