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Lupus

Symtoms of Lupus

02/25/2002

Question:

I`ve read the criteria for diagnosis of lupus, but I`m not clear about the symptoms. I have a positive ANA and my doc is ordering additional tests. I am also taking Mestinon for myasthenia gravis which helps me some, but my doc and I want a second opinion and hopefully a single fiber EMG to obtain a definitive diagnosis on that. (I am also hypothyriod.) I`m assuming that the blood test he ordered for lupus will be negative because I don`t think I have symptoms that fit the criteria; e.i., a rash. I do have joint and neck pain/achiness but it is not disabling. What symptoms does a doctor look for???? A coworker of mine has lupus and she is tired a lot. Is easy fatiguability a symptom?

Answer:

Easy fatiguability is a very nonspecific symptom. People with lupus can definitely have this symptom, but other conditions can present with the same symptom: any form of connective tissue diseases, systemic arthritic conditions (like Rheumatoid Arthritis), endocrine problems (hypothyroidism, adrenal insufficiency), heart diseases, renal diseases, neurologic problems and finally fibromyalgia, chronic fatigue syndrome and even depression.

Lupus has nonspecific symptoms like fatigue, weakness, aches and pains, sometimes fever and more specific problems like certain classical rashes (butterfly rash, inter-articular rashes), oral/nasal ulcerations, arthritis, kidney disease, pleurisy/pericarditis (inflammation of the membranes around heart or lung), certain types of anemia, decrease in leukocyte/thrombocyte number, neurologic problems and finally the auto-antibodies when they present a high-titer. Antinuclear antibody is present but not diagnostic of lupus by itself. There are other auto antibodies which are more specific but not all lupus patients have them and not having them does not mean you can rule out lupus.

Bottom line is that lupus is a clinical diagnosis in which the physician puts together the history, physical findings, certain types of organ involvement, some supportive laboratory studies. ANA can be positive in a multitude of auto immune conditions other than lupus: other connective tissue diseases (scleroderma, polymyositis) autoimmune liver or thyroid disease, interstitial lung disease, autoimmune neurologic conditions, with certain medications; finally relatives of patients with lupus or even healthy population may have positive ANA.

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Response by:

Yolanda   Farhey, MD Yolanda Farhey, MD
Associate Professor
College of Medicine
University of Cincinnati