Brief Answer:
You will need further testing, get the ANA sm Abs and urine protein to creatinine spot ratio done..

Detailed Answer:
Hello and Welcome

I appreciate your concern

I have gone through your reports. SLE ( Systemic Lupus Erythematosis ) also called Lupus, is a systemic disease and can manifest in multiple organ systems. Clinical criterion and labs , both need to be evaluated for consistency before invasive workup and treatment is initiated.

ANA is a screening test for Lupus. The anti ANA ds and SM Antibodies are highly specific for lupus. You should get the sm antibody test by doing a complete ANA profile. Renal manifestations should be looked for by doing a Urine protein to creatinine ratio.

Based upon the results of these investigations, a renal biopsy can be planned which is confirmatory for lupus. Immunosuppressant therapies e.g mycophenolate and corticosteroids should only be started after confirmation by biopsy.

wishing you best of health

thanks

Dr. M.S.Khalil

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Brief Answer:
There is a small chance of false positives, so be ready

Detailed Answer:
Hello again,

I am sorry for your distress.

Even though ds antibodies are specific for lupus, Yes, it very well could be a false positive as the ANA pattern was also negative and sm antibodies weren't done, so chances of false positive are there. However, if the sm antibodies are positive and the protein to creatinine spot ratio also indicates the same , then its more likely to be a true positive.

Thanks.

Dr. M.S. Khalil

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Brief Answer:
history and symptoms alone would be inadequate

Detailed Answer:
hello again.

Based on history and subjective perception alone one can't exclude or prove a diagnosis. Please get the investigations done to be sure and have peace of mind.

thanks.

Dr. M.S. Khalil

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Brief Answer:
no renal issues if 24 hr test is normal, state meds and weight/height

Detailed Answer:
Hi Jacquiline.

I answered the follow up question in the direct question. If you did not get it then I can send it to you in this thread.

Hello again,

If the 24 hour urine is normal then taking into consideration your previous results you can be sure that there aren't any renal manifestations ( lupus nephritis )which is the most dreaded part of SLE and is quite difficult to treat.

If the vitamin d levels are marginally low then there is no need to worry. Adequate Sunlight exposure and vitamin d supplements for a couple of months are all that would be needed.

You can repeat the ANA and ds tests from another lab for confirmation. I would advise you to do an sm antibody test in addition, in consult with your doctor. Even though the symptoms are present, symptoms alone or ANA and ds alone aren't sufficient to label you as a lupus patient.

You are justified to refuse being treated by a doctor if due courtesy is not given to you and all your apprehensions aren't addressed. Though an online interaction isn't a substitute, if you were my patient, I would advise your next step to be an empiric round of NSAIDs ( celecoxib or diclofenac sodium) for two weeks to see for improvement. A second opinion from another Rheumatologist should be sought as you are still experiencing pain in your hands and paresthesia ( tingling sensations. If Lupus , R.A , Gout and spondyloarthropathies are ruled out then you should limit the consultation to an internal medicine specialist (General Physician).

To answer your question, Yes its possible for both ANA and ds to be positive even in the absence of disease. As explained in the previous answer , false positive results can occur.

You mentioned that you are using other medications , too and you are concerned about weight gain and a great deal of hair loss. I would like to gather some more information before commenting on these two issues.

Please state your height and weight to calculate your BMI. Please list all the medications that you are using currently.

Let me know if you have any query.

Thanks.
Dr. M.S.Khalil

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Brief Answer:
associations zoloft/ weight gain,,, naltrexone/hairloss

Detailed Answer:
Hi XXXXXXX

Zoloft ( Sertraline ) use is associated with significant weight gain.
Naltrexone use is associated with alopecia / hair loss.

Association does not necessarily mean causation. However, having said that , I would advise you to taper the dose of Zoloft down as you are already on duloxetine which works pretty much similar to Zoloft.Taper and ultimately try to quit naltrexone.

Please alter the dose of these medicine after consulting your physician.

You can also use ketoconazole and ciclosporin containing shampoos like KETOVIN and CICLOMIN both twice a week along with a zinc containing supplement such as SURBEX Z to see for improvement in hair fall in case an infective cause is present.
Thyroid function tests and a lipid profile would also be indicated. Though your previous lipid profile was in range, so thyroid function tests should suffice.

Thanks.
Dr. M.S. Khalil

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Brief Answer:
cymbalta doesnt cause weight gain, Tests interpretted.

Detailed Answer:
Hi.

Hope you are feeling better.

The Nurontin you are using is unlikely to cause all these effects. Nurontin ( Gabapentin ) is a GABA analogue meaning it has GABA like effect, having analgesic and anticonvulsant properties. The dose you are using is also well within range as gabapentin dose can be used up to 2400 mg / day. Gabapentin is used in a number of conditions including withdrawal symptoms, neuropathies, RLS ( Restless Leg Syndrome), insomnia etc.


Cymbalta is not associated with weight gain. Rather, it causes weight loss in 2 percent of patient population, so you may continue it for now, especially if you are concerned about medication adversely affecting your weight, as mentioned in your previous query.


I have read your latest reports. With normal levels of C3 , C4 and CRP , I don't see the need for a renal biopsy especially if clinical signs also give the same indication. The SM antibody is also negative, which is additional evidence against lupus. The TSH is missing in the thyroid profile. TSH is a very sensitive test, if TSH is normal you can be sure that there is no abnormality with the thyroid.

Let me know if you have any other questions in your mind.

Thanks.
Dr. M.S.Khalil

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Brief Answer:
if a test is not false positive then it means its a true positive

Detailed Answer:
Hi,

I am glad, I was of some assistance.

I rechecked the original tests but could not find TSH. You may post the test result here yourself with the exact units.

One can know for sure , if the ANA and ds were true positives, only if a biopsy is done. Unless a biopsy is done , one cant say for sure that the tests are not false positives. But the likelihood of disease is assessed as a whole picture i.e complement levels and inflammatory markers are well within range , which doesn't occur in Lupus. Also there is no confirmatory evidence for pleural involvement or any other common manifestations like nephritis and skin issues.

So, to answer the question, hypothetically, if in fact, the tests are not false positive then they must be true positive , meaning a diagnosis of SLE (Lupus) will be established.

Let me know if there is any question in your mind.

Dr. M.S.Khalil

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Brief Answer:
yes, you may share the results when available

Detailed Answer:
Hello and welcome.

Melatonin is a pineal gland hormone that helps in regulating the sleep cycle.

Melatonin should only be used if there are indications present. Melatonin is indicated in a wide variety of conditions. Sleep disorders , jet lag , migraines and drug withdrawal ( nicotine and Benzodiazepines , mainly ) , to name a few.

If there is a sure shot indication then you may use it in consult with the kids' doctor. I would advise against long term use. You may skip a month of treatment to see if self regulation has occurred or not.

Yes, you may share the results when they are available.

Thanks.
Dr. M.S. Khalil

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Brief Answer:
taper dose instead of abrupt discontinuation.

Detailed Answer:
hi.

Yes, you may discontinue the melatonin during this phase. But ideally, a slow tapering of the dose rather than abrupt discontinuation would be better. It would limit the effect on disrupting sleep.

thanks.

Dr. M.S.Khalil

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Brief Answer:
yes, that method would be fine

Detailed Answer:
Hi.

Yes, that would be a more appropriate way.

Thanks.

Dr. M.S. Khalil

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