Next Steps?

I am a 40 year old female with 10 years of elusive medical problems.  I am not on any meds. Positive test results are: ESR 30-45 over 10 years, polyclonal gammopathy IgM 1,000 - 1200 since 2002, anterior uveitis 1x 2002, small cataracts in both eyes, pelvic ultrasound - moderate ascites 2005.  Recent Negative/normal test results: ANA,ANCA,AMA,RF,SSA,SSB,Alpha-1-antitrypsin,Hep function panel, CBC w/Diff, Hepatitis Panel,PT/PTT,metabolic panel,Chest CT/contrast.  Recent/current symptoms - Raynaud's, dry eyes, petechiae, shortness of breath /chest tightness(no congestion/mucous)/high BP & pulse (resolved with albuteral nebulizer/inhaler). Past symptoms over 10 years but haven't had in a while: joint pain, fatigue, muscle pain, muscle twitching, numbness/tingling in extremities, confusion/disorientation, DUB.  I have been seeing the same Rheum MD throughout this period and he thinks its a CTD, but takes the "wait-and-see what symptoms develop" approach.  He states there is not much else to test for, which I was ok with, but I am growing more concerned with increase in severity of symptoms and do not want any long term damage/problems.  I see Rheum on 12/11 and want to get some thoughts on my test results, other possible tests and thoughts on symptoms.  Any insights would be greatly appreciated. Thank you.

[Kevin Pho, MD]

I agree that pretty much everything has been tested for.  I can't think of any further blood testing that would be revealing in your case.  

You can consider a cardiac route with the symptoms of high BP, chest tightness and shortness of breath.  A stress echocardiogram can be considered to further evaluate the heart.  If negative, you can consider a pulmonary workup, starting with a pulmonary function test and chest CT scan.

Otherwise, you can consider another rheumatological opinion - preferably at a major academic medical center.

These options can be discussed with your personal physician.

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.

Kevin, M.D.
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