Doctors Lounge - Rheumatology Answers
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Forum Name: Rheumatology Topics
|jackiestar88 - Mon Nov 09, 2009 11:22 am||
I have had a fever of an unknown origin for 6 months now. It usually ranges from 99-100.3. It presents itself everyday. I have been through the ringer with doctors. I am totally fatigued, have wrist pain and abdominal pain/lower back pain. The serum protien test showed a faint discrete band in the gamma region and IGg levels were elevated. I also had a WBC scan that showed increased radiotracer activity in my pelvic region and a Laperoscopy that show a markedly inflamed bowel (outside wall) and a colonoscopy that was normal. My CBC is normal, sedrate is normal, c3 & c4 compliments are within normal range and c reactive protein is normal. However, I tested positive for ANA twice and I also test positive for the Anti DsDNA antibodies. In addition to that, I just developed painless mouth sores underneath my tongue. I went to see the Rheumy and he has pretty much dismissed me because I don't meet all 4 criteria of Lupus, I meet 3 right now. He didn't even reschedule me for a follow up visit. I am so frustrated with these doctors and just don't know what to do. He says it's because my CBC is normal right now although I have heard from many sources that the CBC can be normal in the beggining stages of Lupus or when you are in remission. Can you have a normal CBC and still have Lupus that has not progressed yet? I am so frustrated with these doctors and feel that I need a second opinion. what are your thoughts about my symptoms and test results? I am pretty convinced that I do have Lupus.
|Dr.M.Aroon kamath - Tue Dec 08, 2009 10:06 am||
I can understand your frustration. For a doctor, to label a patient as having SLE is not in any way easy. Symptoms of SLE are highly variable, at times intermittent and overlap symptoms of so many other diseases. This makes diagnosis very challenging.
Understanding the results of the various tests for SLE may be somewhat confusing (more so for patients).
The terms 'sensitivity' and 'specificity' can be confusing(more so for patients).
For example; Anti-dsDNA antibodies are highly specific for SLE; they are present in 70% of cases, whereas they appear in only 0.5% of people without SLE.
This means that this test is more useful to exclude SLE if it is abscent. In other words, it is good in correcly identifying people who don't have the disease.
Similarly, CBC results have higher specificity than sensitivity (approximate sensitivity = 59%; specificity = 89%). So, once again, this means that this test is more useful to exclude SLE if it is normal.
So also, the various criteria for diagnosis of SLE have their own sensitivities and specificities.
Your rheumatologist must have considered these aspects critically before deciding that he/she was not as convinced about 'your' diagnosis as you are.
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