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Arthritis  (Expert Forum)
 | 
Lupus Symptoms
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD Boston - MA
This forum is for questions and support regarding arthritis issues such as: Arthritis, Autoimmune Disease, Bursitis, Fibromyalgia, Gout, Juvenile Rheumatoid Arthritis, Lupus, Myositis, Neuralgia, Osteoarthritis, Polymyalgia Rheumatica, Rheumatoid Arthritis, Sciatica, Tendinitis, Vasculitis.
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MedHelp Member's Question

Lupus Symptoms

by lg5, Sep 29, 2003 12:00AM
I am a 30 year old female.  For the past two months, I have had numerous tests due to a photosensitive reaction and erythema nodosum.  I am concerned how to proceed at this point and I hope you can offer some advice.  



In early August, I was in the midday sun for about an hour.  I noticed a few hours later a sunburn in the areas most exposed (top of forehead, cheeks, shoulder, v of neck).    However, the next morning, a thick bumpy rash had developed on the sunburned areas.  I am a fair-complected person who has had sunburns in the past but no unusual rash reactions.   The following day, I developed erythema nodosum (confirmed by biopsy) on my shins and back of foot. Also, sore, red skin on my elbows.   At this point, I went to an acute care center.  



I was referred to a family physician who sent me to a dermatologist and placed me on 500mg of Naproxen 2x per day with a follow up appointment for the following Tuesday.  At that point the photosensitive reaction was gone (about 7 days later). I noticed that my cheeks did seem slightly flushed though.



I should mention that I never had a fever when checked during my various dr. appointments. BP normal except on the last visit it was 134/86.   On no meds, except the second month of oral contraceptives which I discontinued. (I was on the same OCP before my daughter was born but this time noticed a lot of spotting, etc).



The dermatologist ordered numerous blood tests....electrolytes, CBC, ANA, sed rate, RA plus TB skin test and chest xray. MY sed came back elevated (34), but chest xray, thyroid, TB, ANA, RA and CBC all normal.  The derm said the elevated sed rate could be due to the erythema nodosum.  In the follow visit with the family physician my sed rate was down to 17.   At this point, I was advised by the dermatologist to discontinue the naproxen (after three weeks).   While I was on the Naproxen, I had some stomach irritation and swollen ankles.  



I brought all of these test results to a GP for evaluation.     He noticed high sodium and potassium electrolyte levels in the original blood tests (from the naproxen?) and ordered a new Chem 7 which came back normal.   He said since the  ANA was negative and all the blood tests were normal that we could discontinue the exploration.    



Here are my concerns...Are there any additional blood tests that should be run?  was the ANA run too soon to be positive?  Should they have done a urinalysis?  Is it common to have fluid retention while on naproxen?  



As I have always been a healthy person, this experience has me completely stressed.   Any advice most appreciated.
Doctor's Answer

by Kevin Pho, MD, Sep 29, 2003 12:00AM
There are many causes of E Nodosum.  They can include the following:



1) Infections

Streptococcus

Coccidioidomycosis

Tuberculosis

Hepatitis B

Syphilis

Cat scratch disease

Tularemia

Yersinia

Leptospirosis

Psittacosis

Histoplasmosis

Mononucleosis (EBV)



2) Sensitivity to certain medications

Oral contraceptives

Penicillin

Sulfonamides

Sulfones

Barbiturates

Hydantoin

Phenacetin

Salicylates

Iodides

Progestin



Other associated disorders include leukemia, sarcoidosis, rheumatic fever, and ulcerative colitis.



With most of the tests coming back negative, most of these causes can be ruled out.  One test I would consider would be an antistreptolysin-O titer at diagnosis and two to four-weeks later to assess for antecedent streptococcal infection - since this is the most common cause for E nodosum.  



Regarding the fluid retention, high doses of naproxen (or any NSAID) can result in renal insufficiency, leading to elevated levels of potassium and fluid retention - if the blood levels are normal, then you can be reassured that this has resolved.  



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

Member Comments

by Spring-02, Oct 02, 2003 12:00AM
What is a normal ANA level?  I have been having lupus and neurological symptoms for over two years.  It initially started with a rash around my waist, a lump on my foot and then numbness, burning, stabbing pain and mobility problems.  I have had an MRI, EMG and EEG, all of which are normal.  I get jolting shocks in my sleep and my hands, arms and feet move on their own.  My ANA level was 1:2 and one report indicated possibly due to SLE, yet my doctor tells me that that ratio isn't high and my symptoms are neurological.  I have very brisk reflexes, hypersensitive to noise and light and an exagerrated startle reflex.  I have had allergies for year and was always sensitive to light.  I cannot walk right, as after my foot drop, I developed a high arch on my left foot and now I lean to the right.  I have left sided weakness and weakness in my right forearm.  When I wake up in the morning my hands are numb up to my elbows.  I don't have pain above the knee or elbow and I don't have Sciatic or Back Problems.  The pain in my feet, toes and fingers and especially the arch of my foot is burning and stabbing.  My feet are numb and cold in the day and hot and buring in the night, go figure!!!!!!  My brother is having similar problems with the same leg, but doesn't have speech problems, hypersensitivity or allergies. He has seen two neurologists and they suspected he has either Charcot Marie Tooth or HNPP.  I informed my neuro about that and he said I didn't have Lyme, CMT, or anything like that.  He said my symptoms indicate an upper motor neuron problem but nothing has shown up in the testing.  Now, my 13 year old grandaughter, who also has many allergies has experienced very painful blister like rashes on her face, fingers, hands and feet.  I don't know if there is a heriditary component to all this or what, but it seems like that.  My left eye is always swollen in the corner and somedays it looks like I have two eyelids and no eyelashes with the swelling.  I am taking a water retention pill, allergy meds, Neurontin and 25 mg of Ampitrypline but still don't have a diagnosis and the symptoms are progressive.  When my sister was home this summer on vacation she told my daughter that I was much worse than last year at this time.  I seem to stuttter or can't get the words out and have no idea why.  I stagger at times or lose my balance and it is embarassing.  I go for the Arthritis Pool and Joint Works twice a week.  In the evening I seem to get stiffer and shuffle down the hall like an old man.  I need my arms and hands to get myself out of the chair.  It has been a drastic change of lifestyle for me as I had a full time job and was very active physically, walking every day, golfing and bowling.  I saw a psychiatrist as required by my

DI Insurance and he verified that I am not clinically depressed, anxious or making this all up.  Having all these weird symptoms happening to you and not knowing why, or getting any treatment is very hard to tolerate but you just have to learn to make the most of it.  



I hope that everybody keeps up with the messages and that we try to help each other, at least with support and best wishes.



Good luck,

The Canadian

by notluckyme, Nov 04, 2003 12:00AM
I HAVE BEEN SUFFERING WITH JOINT AND BONE PAIN, HAIR