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What Causes Severe Joint Pain And Fatigue?
Question: Had a high ANA, now it is neg. Was I wrongly diagnosed for PBC 15 years ago. Pain and fatigue is helped by Prednisone.
Brief Answer:
Follows.
Detailed Answer:
Dear Madam,
Thank you for posting your query on HCM.
Well looking into your problem I would like to tell you that for confirmation Liver biopsy is necessary but still am not clear about the type of autoimmune disease you are having .
I think you should get ESR , CPK , ENA PROFILE , anti ds DNA levels done to see whats going on . Just for fatigue and pain prednisone cannot be taken until and unless you are diagnosed with polymyalgia rheumatica .
Please let me know all the details and your exact query.
Take care.
Dr. Shruti
Follows.
Detailed Answer:
Dear Madam,
Thank you for posting your query on HCM.
Well looking into your problem I would like to tell you that for confirmation Liver biopsy is necessary but still am not clear about the type of autoimmune disease you are having .
I think you should get ESR , CPK , ENA PROFILE , anti ds DNA levels done to see whats going on . Just for fatigue and pain prednisone cannot be taken until and unless you are diagnosed with polymyalgia rheumatica .
Please let me know all the details and your exact query.
Take care.
Dr. Shruti
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I was having a lot of fatigue and pain in joints, my gastro suggested I see a rheumatologist. He said pbc causes a lot of anti immune diseases. I'm confused because all the blood test has came back normal. Take ursodial, liver biopsy had said PBC, 15 years ago. The reason the biopsy was done back then was because of a high ANA. Now I am beginning to think I was miss diagnosed, because of the normal blood work.
The prednisone was prescribed for a different issue. I had a rash, and that is why they prescribed it, but I noticed a big difference in my pain after I started it.
I did have all these test you suggested, they are normal except the ERP is .72, normal I understand is less than .52. rbc. Sed. rate auto, antinuclear, cmp. cbc, cyclic peptide, rheumatoid factor, is all normal.
If I had PBC, I'd think the Antinuclear would still be high???
The reason for the Rheumatologist call was because, the pain and fatigue had increased so much, now I wonder ?????
The prednisone was prescribed for a different issue. I had a rash, and that is why they prescribed it, but I noticed a big difference in my pain after I started it.
I did have all these test you suggested, they are normal except the ERP is .72, normal I understand is less than .52. rbc. Sed. rate auto, antinuclear, cmp. cbc, cyclic peptide, rheumatoid factor, is all normal.
If I had PBC, I'd think the Antinuclear would still be high???
The reason for the Rheumatologist call was because, the pain and fatigue had increased so much, now I wonder ?????
Brief Answer:
Follows.
Detailed Answer:
Dear Madam,
Pain and fatigue occur in fibromyalgia or chronic fatigue syndrome also . And yes with PBC other autoantibodies should be positive plus your liver functions will also be affected . CRP signifies acute inflammation so is positive in any infection and is not specific .
Since the autoantibodies are not positive it will be difficult to label it like that.
Dr. Shruti
Follows.
Detailed Answer:
Dear Madam,
Pain and fatigue occur in fibromyalgia or chronic fatigue syndrome also . And yes with PBC other autoantibodies should be positive plus your liver functions will also be affected . CRP signifies acute inflammation so is positive in any infection and is not specific .
Since the autoantibodies are not positive it will be difficult to label it like that.
Dr. Shruti
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Will the urso., alone be responsible for the good liver test, etc. Still don't see answer to if it was possible to have been miss diagnosed?
Do you think another biopsy is necessary, also I understand after 15 years, you would see more liver damage going on if I have PBC.
Also have had MRI's every 6 months. They never seem to change???
Do you think another biopsy is necessary, also I understand after 15 years, you would see more liver damage going on if I have PBC.
Also have had MRI's every 6 months. They never seem to change???
Brief Answer:
Follows.
Detailed Answer:
Dear Madam,
Thanks for reverting back.
Ursodial alone will not be able to hold the disease so well that LFT remain normal all these years . Rather then getting another biopsy done first please get your earlier biopsy slides reviewed by another pathologist , lets see what does he opine about it. Since it is an observer dependent test variation in reporting may be possible .
Do you also have other features of PBC like darkening of skin etc. Because biopsy needs to be seen in clinical context.
Dr. Shruti
Follows.
Detailed Answer:
Dear Madam,
Thanks for reverting back.
Ursodial alone will not be able to hold the disease so well that LFT remain normal all these years . Rather then getting another biopsy done first please get your earlier biopsy slides reviewed by another pathologist , lets see what does he opine about it. Since it is an observer dependent test variation in reporting may be possible .
Do you also have other features of PBC like darkening of skin etc. Because biopsy needs to be seen in clinical context.
Dr. Shruti
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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