Possible RA or Lupus?

[mamabland]

Dr Keyes, its me again. Still here but have more info- syphillis has been r/o. TG! Kidney bx: thin basement membrane disease, but 1 glomeruli showed gobal sclerosis but that was 1 out of ~ 24.  Good news, no?  Last inpt stay 07/28 (kidney bx done on 07/31/09) bld wk as follows: WBC 16.9 H  RBC 5.47H  HGB 16.8H  HCT 48.9H MCV 89.5  MCH 30.7  MCHC 34.3  RDW 13.3  platelets 301 Auto Diff pass  Neut auto 65  lymp auto 28 mono auto 7  eos auto 1  baso auto 0  sed rate drawn at 2000 on 7/28, at 0405 was 10, then at 2230 was 9.  Initial U/A mod occult blood, RBC 13, WBC 3, Bacteria mod, squamous epith. 2, mucus rare.  CMP: gluc119 H, BUN 7L, Ca 10.2H, Amylase 19L, Na 146 H, Chloride 109H.  On  07/30 dev crit low K+ of 2.9l.  Hx crit low K+ on last inpt 05/09. Since July have felt much better w/ markedly less fatigue and kid pain, but much worse jt pain and swelling, usually bilat knees, but now lt knee and lt hip worse. 2x knees totally went out on me 2nd x was on asphalt w/ my hands full, fell on lt knee with almost all of my weight, which at this point has become significant!  X-ray res: 0 fxs, f/u with PCP, on exam states bilat knees with bursitis/arthritis "lots fluid", wtng for auth for MRI of lt knee /lt hip, lower back is extr pain occ/stiff. 01/09 initial ANA was neg.latest ESR nml. Friend w/ RA says had RA for 10 yrs before it showed up on typical blood tests and that her doctor told her this was not uncommon??? Nxt bld wk for P-ANCA, C-ANCA, CMP, RPR.   W/ my own research and labs I am thinking RA or possibly SLE.  Other S/S I may have forgotten to mention- alopecia, rash on bilat arms chest and face that look like folliculitis but produce little tiny white cysts, large cystic type lesions on armpit areas, breasts and groin that are like "blood cysts" only contain blood and sm amt of puss, but seem cavernous inside - can insert the entire length of medium safety pin without pain after initial penetration into hole.  What do you think Doc?

[J.M. Keyes, MD]

thanks for the update.
glad to hear you have ruled out syphillis and don't have that hanging over your head anymore.  your body certainly hasn't gone the simple, straight forward route!  SLE is one of those things that can be missed and difficult to diagnose.  I think that it is a possibility. It sounds like you have had a lot of investigations, and a referral to a rheumatologist is something to consider if you and your PCP are still unable to come to any conclusions with the awaiting tests. your other symptoms may or may not be related... the cystic lesions sound like hydradenitis suppurativa (obviously can't diagnose without examining you), and this can be linked with autoimmune diseases (which SLE and RA are).  Treatment ranges from compresses/antibiotics to surgery and laser depending on severity.
Good luck with everything.
JMK MD

[mamabland]

Dr. Keyes, Once again thanks so much for your valuable input and expertise.  Hopefully I can get the Rheumatologist referral before I end up back in the hospital again.  They finally got rid of my PCP's MA that was not doing her job.  I kept telling my doc (and bless his heart, he defended her to the hilt) that I would call my insurance company only to be told that they had not heard fr my PCP w/ referral/auth request.  They are finding things from back in March that she hid away and did not do.  At least now they know that I am not a raging lunatic/bit*h.  I will take what I can get!  Is it true from my above post that RA can show symptoms for a long time before lab tests confirm?  Also, were the kidney bx results significant? I know I probably sound impatient, but I am just so tired of hurting and not knowing why.  It has taken all of my vitality, my confidence.  I no longer feel like I am good at anything, wife, mother, friend, etc and I used to be the energizer bunny, I was everything to everybody, now I am just this useless pile of flesh and pain!  Sorry for the dramatics and self-pity.  I just really would like to know why and what I can do to get it gone or at least under control to get back to some semblance of "me" if you know what I mean!  Thanks again Dr. Keyes.  I REALLY wish you lived in AZ!  Sincerely, Terri