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what is this differential lupus diagnosis

Thats my question!  Actually I have many but we'll start slow.  I was just diagnosed about a week ago.  I've been through the wringer of medical issues in the last 4 months.  I've had hypertension for as long  as I can remember, I was diagnosed with fibro 5 years ago, just this past July was hospitalized for renal failure and was so anemic I had to be given blood.   I'm on a unbelievable number of medications for everything.  I just sought out a rheumy in August.  Of course he ran the gamet of tests and his exact words from the begining has been "without a doubt you have fibromyalgia digenerative disk disease, and arthritis but theres more and I will find out what it is."  Then I get this diagnosis that makes no sense to me.  Does anyone understand it?
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I've found this very helpful in order to help me help my doctor's with my diagnosis - see below!
Best Wishes!

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the presence of several autoantibodies, formation of immune complexes (ICs), and inflammation in different organs.


•Pathophysiology of SLE is not completely understood; however, the following have been implicated
◦Apoptosis (programmed cell death) leading to loss of immune tolerance
◦Interferon-alpha (IFN-α) and plasmacytoid dendritic cells (PDCs)
◦Toll-like receptors (TLRs) through the induction of IFN--α by PDCs
•Multiple pathogenic antibodies have been discovered
◦Double-stranded DNA (dsDNA)
◦Ro (anti-SSA)
◦Smith (Sm)
◦Antiphospholipid antibodies (anticardiolipin and beta-2 glycoprotein I)
◦Lupus anticoagulant
◦La (anti-SSB)
Clinical Presentation

•Dermatologic – malar discoid rash, photosensitivity, skin eruptions, alopecia
•Musculoskeletal – arthritis, arthralgia, myalgia
•Serositis – pleuritis, pericarditis
•Renal – nephritis
•Neurologic – seizures, psychosis, mood disorders, stroke, chorea
•Hematologic – hemolytic anemia, leukopenia, thrombocytopenia, antiphospholipid syndrome symptoms
•Cardiovascular – vasculitis, transient ischemic attack, Libman-Sachs endocarditis
•Ocular – sicca syndrome
◦Osteoporosis – probably combination of disease inflammation and steroids used in treatment
•Increased risk of hematologic cancer and non-Hodgkin lymphoma
•Hepatobiliary cancers increased in men
•Early coronary heart disease
◦Adverse pregnancy outcomes

•Immunosuppressives are currently the mainstay of therapy

•Indications for testing – multisystem disease presentation
•Laboratory testing
◦Initial testing – not disease-specific but may be helpful in determining organ involvement
•CBC – anemia, thrombocytopenia, leukopenia
•Urinalysis – hematuria; indicates renal disease
•Liver transaminases – may be elevated
•BUN/creatinine – may be elevated; indicates renal disease
•ANCA – rule out vasculitis
◦Anti-nuclear antibody (ANA) test is useful as initial screen for SLE; ANA is not disease-specific and positive samples should be tested to identify antibodies specific for SLE
•dsDNA of >1:10 detected by immunofluorescence assay (IFA) – 50-60% of SLE
◦Presence of high antibody titers to native dsDNA is specific and diagnostic for SLE
•Extractable nuclear antigens (ENA)
◦Smith (Sm) antibodies – highly specific for SLE but occur in only 30-35% of cases
◦Ribonucleic protein (RNP) antibodies – not specific for SLE
◦SSA and SSB antibodies  – not specific for SLE
•Histone and ssDNA antibodies – not specific for SLE
Differential Diagnosis

•Other autoimmune diseases
◦Mixed connective tissue disease (MCTD)
◦Sjögren syndrome
•Antiphospholipid syndrome (APS)
•Drug-induced lupus

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