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Question: I have a positive ANA homogenous with a titer of 1:640. My CRP is 2.35, my SM is 4 with a range of 1-120, SSA 22 with a range of 1-120, SSB 7 with a range of 1-120, a RNP OF 14 with a range of 1-120 and a RF of 8.7 with a range of <14. I have fibromyalgia and the fatigue and pain have increased tremendously oner the last few months. I have muscle a joint pain. I have had a low grade fever since May and I have scaley skin issues on my arm and face sometimes. It has been suggested I have rosacea, but my redness does not follow those symptoms. I have been having great difficulties for over 10 months. A lot of my nutrient levels are critically low and I have been diagnosed with secondary aldosteronism. Any ideas? Also can you explain why the lab reported my SSA, SSB, SM, RNP, etc as normal when the guidelines from the mayo clinic shows those as being positive if they are greater than 1? Thank you!
Brief Answer:
Positive ANA implications
Detailed Answer:
Good evening,
Thank you for writing on health care magic.
Well, I have gone through your results and I understand the frustration you are in.
At this stage, I am not sure at all if you have fibromyalgia. Your ANA is very strongly positive. The rash, fatigue, low grade fever, joint pains do point towards a connective tissue disease something like Lupus. But yes, I would like to confirm it only after examining you. But I won't wanna ignore the Positive ANA here. I see your appointment with rheumatologist is scheduled after 2 months. But you need to consult your physician about it, on why it cant be a connective tissue disease than lupus.
Could you let me know the values for sodium, potassium as well to label it as secondary aldosteronism. I do want to see the reports of your kidney function tests and urine routine as well. The swelling of legs also needs a cause to be evaluated.
If you could attach the reports here, it would be more helpful.
As for the SSA, SSB, RNP and SM, it does vary from lab to lab and depends on the Kit they are using. Even at our center, we use less than 1 as a cut off. So I am not too sure about the method they are using. If needed you can get it tested from a different center.
I am not convinced you have fibromyalgia at this stage. I would like to rule out the other conditions before labeling any patient as fibromyalgia.
Looking forward to seeing your reports
Do let me know for more queries
Would be happy to help you out
Regards
Dr Naval
Positive ANA implications
Detailed Answer:
Good evening,
Thank you for writing on health care magic.
Well, I have gone through your results and I understand the frustration you are in.
At this stage, I am not sure at all if you have fibromyalgia. Your ANA is very strongly positive. The rash, fatigue, low grade fever, joint pains do point towards a connective tissue disease something like Lupus. But yes, I would like to confirm it only after examining you. But I won't wanna ignore the Positive ANA here. I see your appointment with rheumatologist is scheduled after 2 months. But you need to consult your physician about it, on why it cant be a connective tissue disease than lupus.
Could you let me know the values for sodium, potassium as well to label it as secondary aldosteronism. I do want to see the reports of your kidney function tests and urine routine as well. The swelling of legs also needs a cause to be evaluated.
If you could attach the reports here, it would be more helpful.
As for the SSA, SSB, RNP and SM, it does vary from lab to lab and depends on the Kit they are using. Even at our center, we use less than 1 as a cut off. So I am not too sure about the method they are using. If needed you can get it tested from a different center.
I am not convinced you have fibromyalgia at this stage. I would like to rule out the other conditions before labeling any patient as fibromyalgia.
Looking forward to seeing your reports
Do let me know for more queries
Would be happy to help you out
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
I dont know how to attach the reports. My potassium is 3.9, nut i take 80 MEs a day to get it there. Atbone point it was 1.9. He diagnosed the sexondary aldosteronism based on the renin being 105.5 and the aldosterone being 42.5 and cortisol being normal with the 24 hr urine collection. Mu sodium is tested regularly with my potassium. It is always normal. The last sodium test was 139. My BUN is normal. The latest being 12. My creatinine is usually normal with the last being .7. When it is not normal, it is barely oitnof range on the low side. I do have a UA showing high protein, but i think i had a kidney infection. As for the edema, i have had that problem for a while and have taken diuretics daily for years which took care of it. Because of the low potassium, they changed my diuretic and my feet and calves swell do bad that i have had to cut my socks off before. That is after sitting all day. If i stand all day, its excrutiating and the swelling is horrible. I alsi have hot poker type sensations at the bottom of my feet and my hands and feet are asleep alot. Ifyou list the specific labs you want, i probalbly haveWhen you get a chance, I need Marcia's contact information. Is she a general sped consultant them. You will have to use the letters the lab uses so i will know what you want. I apologize for the typos. Im on my phone and dont know how to continue with you if i switch to the laptop. Autocorrect here would help.
Brief Answer:
? Is it Lupus
Detailed Answer:
Good evening
Well firstly, dont worry about the typos.It is totally fine.
I have gone through the reports you have texted. Well, the results you are telling doesnt look like aldosternoism. It could be very well be a part of lupus which is affecting the kidneys. Firstly i would suggest you to repeat the urine routine. If you are leaking protein, that very well could explain the edema in the feet you are having.
There is an option of uploading reports here while using your laptop or desktop. Kindly do so as i do want to look at lot of other parameters as well, like urine for casts/rbc.I also want to know how much your ESR, Serum Albumin and Complete Blood counts are
It will help us give a clue and come close to your diagnosis. Lets leave fibromyalgia aside for a while..
Await your reply
Regards
Dr Naval
? Is it Lupus
Detailed Answer:
Good evening
Well firstly, dont worry about the typos.It is totally fine.
I have gone through the reports you have texted. Well, the results you are telling doesnt look like aldosternoism. It could be very well be a part of lupus which is affecting the kidneys. Firstly i would suggest you to repeat the urine routine. If you are leaking protein, that very well could explain the edema in the feet you are having.
There is an option of uploading reports here while using your laptop or desktop. Kindly do so as i do want to look at lot of other parameters as well, like urine for casts/rbc.I also want to know how much your ESR, Serum Albumin and Complete Blood counts are
It will help us give a clue and come close to your diagnosis. Lets leave fibromyalgia aside for a while..
Await your reply
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Raju A.T
All I have are paper copies. I will do my best to list all of the results and I will double check the numbers.
For some reason the report does not list the tests in order of the panels they belong in. Not sure why...
First set of bloodwork from first endocrinologist that diagnosed secondary hyperaldosteronism
09/16/2014
Test results range
Aldosterone 42.5 0-30
Renin Ativity 105.5 No range given
Vit D 12.8 No range given
PTH intact 33 15-65
Calcium 10.5 No range given
Magnesium 1.7 No range given
Potassium 3.3 No range given
Creatinine Serum 1.06 No range given
Cortisol WNL No range given
**please note that at the time of these tests, I was taking 80 ME of potassium and 400 mg of magnisium per day and had been doing so for at least one month.
The results from the second endocrinologist since the first ran limited tests and my doc had doubts about the findings.
11/19/24
Test Results Range
CRP 2.35 <.5
% Sat 17 20-45
Glucose 92 70-106
LY% 23 13-43
Vit D 25-OH 34.5 30-100
NE# 8.16 1.8-7.7
SSA 22 0-120
eGFR 90.81 >60
EO# .17 0-.4
Free T3 3.4 2.0-4.9
Alk Phos 96 53-128
SGOT 15 15-48
LY# 2.73 .6-4.3
ANA Positive Negative
ANA Titer 1:640 None given
MPV 7.5 6.5-13
LU# .11 .00-.4
WBC 11.64 4.3-9.9
RBC 5.08 3.9-5.10
Chloride 101 100-110
NE% 70.7 48-78
TPo <.02 .0-10
MCV 91 80-99
RDW 14.4 11.6-15
BA# .12 .00-120
MCHC 33.5 30-34
MCH 30.5 27-31
CO2 24 21-30
EO% 1.5 0-4.3
Tsh 2.1 .6-4.8
LUC 1.0 0.0-4.0
Mo% 3.0 3-10
RNP 14 1-120
Albumin 4.3 3.6-4.7
HGB 15.5 12-15.6
MO# .34 .10-1.00
SM 4 1-120
SGPT 11 13-40
Ferritin 34.5 Not given
ANA pattern Homnogeneous
Potassium 3.9 3.5-5.5
Free T4 .92 .75-1.54
T Protein 7.3 6.4-8.9
UIBC 357 155-300
HCT 46.2 36.9-48.1
Calcium 9.7 8.6-10.5
BillirubinT .4 .3-1.9
Creatinine .7 .6-1.3122
Iron 73 50-212
RF 8.7 <14
BUN 12 6-22
BA% 1 0-2
PLT 444 140-450
iron binding 430 250-450
Pth 41.9 8.2-83.5
SSB 7 1-120
Again, I was on 80 ME of potassium, 400 mg of magnesium, and added 2000 units of Vit D3. After the results came in he put me on ferrous sulf 2X a day. for iron deficiency which I don't understand since the iron was in the range.
This endocrinologist ordered more tests on 12/4 checking for cytomeglavirus type stuff or something. He also ordered the DNA type test that goes along with connective tissue disease, but I don't have access to those results yet. He said he feels strongly that I have a connective tissue disease (he has no idea which one) or some sort of weird virus. My doc agrees with the connective tissue disease, but he, too, has no idea which one. I have an appointment with the rheumatologist that diagnosed my fibromyalgia all of those years ago so I can get shots in my knees. I don't trust his judgement to help with this. He was the one that said after getting my results and only seeing me on the day the blood was drawn and the day he gave me my results, that I had no issues other than fibromyalgia and that since most of the test were negative there was no reason to ever repeat them because they would not change. Had I know differently, I would have been pursuing this option long ago. I worry that I have been having major symptoms for about 10 months and will have to go another 2 1/2 or so months with no help. I really worry about my kidneys in the mean time. If you do feel it is lupus or a different diagnosis, what can I do my self (home remedy type thing, I guess) to help me until I get in to my appointments? What types of questions do I need to ask, and what do I bring up. I have learned that I have to stand up for my self, because most of the specialists I have seen don't care. I will say the last endocrinologist I saw went from door to door at the diagnostic clinic trying to get a rheumatologist to see me that day, but came up empty handed. I do believe he is truly concerned. I just need help! Thank you.
I forgot to add the UA from 9/3/2014
Test Result Normals
color yellow yellow
clarity Hazy clear
SP Grav 1.005 1.005-1.025
PH 8 5-7
Leuk Est Negative Negative
Nitrite Negative Negative
Protein + (only value given) Negative
Gluc Negative Negative
Keytones Negative QUAL Negative
Urobilinogen Negative 0.1-1.0
Bilirubin Negative Negative
Blood Negative Negative
For some reason the report does not list the tests in order of the panels they belong in. Not sure why...
First set of bloodwork from first endocrinologist that diagnosed secondary hyperaldosteronism
09/16/2014
Test results range
Aldosterone 42.5 0-30
Renin Ativity 105.5 No range given
Vit D 12.8 No range given
PTH intact 33 15-65
Calcium 10.5 No range given
Magnesium 1.7 No range given
Potassium 3.3 No range given
Creatinine Serum 1.06 No range given
Cortisol WNL No range given
**please note that at the time of these tests, I was taking 80 ME of potassium and 400 mg of magnisium per day and had been doing so for at least one month.
The results from the second endocrinologist since the first ran limited tests and my doc had doubts about the findings.
11/19/24
Test Results Range
CRP 2.35 <.5
% Sat 17 20-45
Glucose 92 70-106
LY% 23 13-43
Vit D 25-OH 34.5 30-100
NE# 8.16 1.8-7.7
SSA 22 0-120
eGFR 90.81 >60
EO# .17 0-.4
Free T3 3.4 2.0-4.9
Alk Phos 96 53-128
SGOT 15 15-48
LY# 2.73 .6-4.3
ANA Positive Negative
ANA Titer 1:640 None given
MPV 7.5 6.5-13
LU# .11 .00-.4
WBC 11.64 4.3-9.9
RBC 5.08 3.9-5.10
Chloride 101 100-110
NE% 70.7 48-78
TPo <.02 .0-10
MCV 91 80-99
RDW 14.4 11.6-15
BA# .12 .00-120
MCHC 33.5 30-34
MCH 30.5 27-31
CO2 24 21-30
EO% 1.5 0-4.3
Tsh 2.1 .6-4.8
LUC 1.0 0.0-4.0
Mo% 3.0 3-10
RNP 14 1-120
Albumin 4.3 3.6-4.7
HGB 15.5 12-15.6
MO# .34 .10-1.00
SM 4 1-120
SGPT 11 13-40
Ferritin 34.5 Not given
ANA pattern Homnogeneous
Potassium 3.9 3.5-5.5
Free T4 .92 .75-1.54
T Protein 7.3 6.4-8.9
UIBC 357 155-300
HCT 46.2 36.9-48.1
Calcium 9.7 8.6-10.5
BillirubinT .4 .3-1.9
Creatinine .7 .6-1.3122
Iron 73 50-212
RF 8.7 <14
BUN 12 6-22
BA% 1 0-2
PLT 444 140-450
iron binding 430 250-450
Pth 41.9 8.2-83.5
SSB 7 1-120
Again, I was on 80 ME of potassium, 400 mg of magnesium, and added 2000 units of Vit D3. After the results came in he put me on ferrous sulf 2X a day. for iron deficiency which I don't understand since the iron was in the range.
This endocrinologist ordered more tests on 12/4 checking for cytomeglavirus type stuff or something. He also ordered the DNA type test that goes along with connective tissue disease, but I don't have access to those results yet. He said he feels strongly that I have a connective tissue disease (he has no idea which one) or some sort of weird virus. My doc agrees with the connective tissue disease, but he, too, has no idea which one. I have an appointment with the rheumatologist that diagnosed my fibromyalgia all of those years ago so I can get shots in my knees. I don't trust his judgement to help with this. He was the one that said after getting my results and only seeing me on the day the blood was drawn and the day he gave me my results, that I had no issues other than fibromyalgia and that since most of the test were negative there was no reason to ever repeat them because they would not change. Had I know differently, I would have been pursuing this option long ago. I worry that I have been having major symptoms for about 10 months and will have to go another 2 1/2 or so months with no help. I really worry about my kidneys in the mean time. If you do feel it is lupus or a different diagnosis, what can I do my self (home remedy type thing, I guess) to help me until I get in to my appointments? What types of questions do I need to ask, and what do I bring up. I have learned that I have to stand up for my self, because most of the specialists I have seen don't care. I will say the last endocrinologist I saw went from door to door at the diagnostic clinic trying to get a rheumatologist to see me that day, but came up empty handed. I do believe he is truly concerned. I just need help! Thank you.
I forgot to add the UA from 9/3/2014
Test Result Normals
color yellow yellow
clarity Hazy clear
SP Grav 1.005 1.005-1.025
PH 8 5-7
Leuk Est Negative Negative
Nitrite Negative Negative
Protein + (only value given) Negative
Gluc Negative Negative
Keytones Negative QUAL Negative
Urobilinogen Negative 0.1-1.0
Bilirubin Negative Negative
Blood Negative Negative
Brief Answer:
Is it lupus?
Detailed Answer:
Good evening
Sorry for the late reply. Was caught up in some work
1. I have gone through your reports. Most of them look normal except the urine protein and the ANA. Considering the symptoms you are having and the urine protein leak we need to repeat the urine sample once again. If possible, collect 24 hour urine sample and check for the protein content in that. It will give us a definite idea on how much the protein leak is
2. Your albumin level (4.3) is normal. So that is probably not causing the swelling of the feet. For the swelling, we need to look into the veins of the legs as well in case they leak on prolonged standing.
3.I couldnt find the ESR report. High ESR with ANA positivity will give us more of an indication that it is a connective tissue disease. Probably Lupus or Sjogrens Syndrome. Also, i do wanted to know if you experience dryness of mouth( like do you feel you have to drink lot of water while eating, or do you experience dryness of the eyes like a foreign particle).
4. I would also recommend you to do Complement C3, C4, Anti Ds DNA antibody. That will also confirm if the kidney involvement is serious or not. The nephrologist you will be meeting, can look into this.
5. Lastly there are no home remedies you can do if it is lupus. Best is to sort it out as early as you can and start treatment. Meanwhile, do avoid Sun exposure just in case it is lupus. Use Sun Scream worth SPF 50 when you go out.
You can get these tests done and let me know as well. So i can help you prepare the questions when you meet the rheumatologist. I don't understand why the appointments are so delayed. In our country, you can meet 3 different rheumatologists within a week if needed.
Hope the information has been useful
Feel free to ask me for more queries if needed
Regards
Dr Naval
PS: Don't worry too much, so far your blood reports are good. Even if it is lupus, it looks to be involving only minor organs. But yes i do want to have a look at the kidneys.
Is it lupus?
Detailed Answer:
Good evening
Sorry for the late reply. Was caught up in some work
1. I have gone through your reports. Most of them look normal except the urine protein and the ANA. Considering the symptoms you are having and the urine protein leak we need to repeat the urine sample once again. If possible, collect 24 hour urine sample and check for the protein content in that. It will give us a definite idea on how much the protein leak is
2. Your albumin level (4.3) is normal. So that is probably not causing the swelling of the feet. For the swelling, we need to look into the veins of the legs as well in case they leak on prolonged standing.
3.I couldnt find the ESR report. High ESR with ANA positivity will give us more of an indication that it is a connective tissue disease. Probably Lupus or Sjogrens Syndrome. Also, i do wanted to know if you experience dryness of mouth( like do you feel you have to drink lot of water while eating, or do you experience dryness of the eyes like a foreign particle).
4. I would also recommend you to do Complement C3, C4, Anti Ds DNA antibody. That will also confirm if the kidney involvement is serious or not. The nephrologist you will be meeting, can look into this.
5. Lastly there are no home remedies you can do if it is lupus. Best is to sort it out as early as you can and start treatment. Meanwhile, do avoid Sun exposure just in case it is lupus. Use Sun Scream worth SPF 50 when you go out.
You can get these tests done and let me know as well. So i can help you prepare the questions when you meet the rheumatologist. I don't understand why the appointments are so delayed. In our country, you can meet 3 different rheumatologists within a week if needed.
Hope the information has been useful
Feel free to ask me for more queries if needed
Regards
Dr Naval
PS: Don't worry too much, so far your blood reports are good. Even if it is lupus, it looks to be involving only minor organs. But yes i do want to have a look at the kidneys.
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Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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