Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Fatigue And Nausea When Diagnosed With Butterfly Rash On The Face?
Question: I have a butterfly rash on my face, don't feel like I am getting enough air, joint pain in my arms and hips, low grade temp off and on, nausea after eating often, finger tips and toes always cold, fatigue. I have a positive ANA but negative ESR. My CRP is 8 and my MPV 10.8, AST 52, ALT 73. I am not a drinker and I have been negative for hepatitis.my Dr. states that my other "lupus" tests are negative but since I have all the symptoms he suggests that I see a rheumatologist. If there are no specific tests for this but I meet most all of the symptoms - photosensitivity to the point of my arms being sunburned after being outside for 2 hours AND wearing long sleeves.
If I am outside for any length of time in the sun I will be in bed for the next full day. What else can I do?
If I am outside for any length of time in the sun I will be in bed for the next full day. What else can I do?
Brief Answer:
Sun protection as well as a sunscreen
Detailed Answer:
Hello. Thank you for writing to us
I am dr.kakkar (dermatologist). I have gone through your query and I have noted your concern.
You should wear a broad spectrum sunscreen (sof 50+) all the time during the day. Reaply every 2-3 hours. Stay away from sun as much as possible.
You should specifically get tested for dsDNA antibody as this a marker for renal involvement in lupus.
Rheumatology consultation is a must
Regards
Sun protection as well as a sunscreen
Detailed Answer:
Hello. Thank you for writing to us
I am dr.kakkar (dermatologist). I have gone through your query and I have noted your concern.
You should wear a broad spectrum sunscreen (sof 50+) all the time during the day. Reaply every 2-3 hours. Stay away from sun as much as possible.
You should specifically get tested for dsDNA antibody as this a marker for renal involvement in lupus.
Rheumatology consultation is a must
Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
I understand the need of seeing a rheumatologist BUT if I have all the symptoms but only the ANA came back positive and the titres "normal" what else is the Dr really going to do? Not trying to be difficult but don't have the money to spend on a lot of expensive tests. Wouldn't they still just treat the symptoms since there is no cure? Can they diagnose Lupus just based on all the symptoms and positive ANA since I have already had the titres and they are within normal values?
or am I looking at something different? I know Lupus is called the great imitator is there another disease that has all the same symptoms since I have all of them?
I have been ill for over 6 years and it comes and goes - I have been diagnosed with chronic mono (which I know is rare) could that give all the same symptoms?
The only difference is the rash on my face which has only been the last year - it lightens on good days - is crimson on bad where even concealer and foundation won't hide it.
or am I looking at something different? I know Lupus is called the great imitator is there another disease that has all the same symptoms since I have all of them?
I have been ill for over 6 years and it comes and goes - I have been diagnosed with chronic mono (which I know is rare) could that give all the same symptoms?
The only difference is the rash on my face which has only been the last year - it lightens on good days - is crimson on bad where even concealer and foundation won't hide it.
Brief Answer:
Regarding further lab testing
Detailed Answer:
Hi.
Clinical judgement gives an initial clue for diagnosing lupus but this may then be more reliably established by lab tests for systemic involvement and by testing for antibodies that are specific to lupus. You are a female patient with a history of photosensitivity along with malar rash and history of joint pains, fatigue, low grade fever and a positive ANA titre and therefore lupus is a possibility but that needs to be confirmed with more specific tests for lupus like antibody against dsDNA and Sm antigens. There are so many other connective tissue diseases which can have positive ANA e.g Scleroderma, Sjogren's Syndrome, Dermatomyositis and other conditions like autoimmune thyroidits, pernicious anemia etc. XXXXXXX college of Rhematology (ACR) has defined 11 criteria (clinical and laboratory criteria), out of which 4 should be present for a diagnosis of lupus. Photosensitivity and malar rash are 2 of them. ANA is also one of the criteria and so are antibodies against dsDNA and Sm antigens besides other lab test like complete blood count, anti phospholipid antibody and RPR. So based on your symptoms and lab tests, you meet 3 of these 11 criteria; 2 clinical, namely photosensitivity and malar rash and 1 laboratory i.e positive ANA (does'nt matter if its within normal limits because this does'nt exclude lupus). Therefore other tests need to be carried out in order to establish the diagnosis and define prognosis.
Besides being specific for lupus, dsDNA is also a Lab test of certain prognostic significance. A high antibody titre against dsDNA indicates a poor prognosis and renal involvement that requires aggressive measures. Similarly renal involvement can be predicted with other lab tests urinalysis and serum creatinine and Blood Urea Nitrogen (BUN).
Yes, lupus is a great imitator and that itself is an indication for more specific lab tests!!
A rheumatologist would also rule out other diseases with joint involvement like rheumatoid arthritis which is all the more relevant specially since you have a low titre of ANA.
Regards
Regarding further lab testing
Detailed Answer:
Hi.
Clinical judgement gives an initial clue for diagnosing lupus but this may then be more reliably established by lab tests for systemic involvement and by testing for antibodies that are specific to lupus. You are a female patient with a history of photosensitivity along with malar rash and history of joint pains, fatigue, low grade fever and a positive ANA titre and therefore lupus is a possibility but that needs to be confirmed with more specific tests for lupus like antibody against dsDNA and Sm antigens. There are so many other connective tissue diseases which can have positive ANA e.g Scleroderma, Sjogren's Syndrome, Dermatomyositis and other conditions like autoimmune thyroidits, pernicious anemia etc. XXXXXXX college of Rhematology (ACR) has defined 11 criteria (clinical and laboratory criteria), out of which 4 should be present for a diagnosis of lupus. Photosensitivity and malar rash are 2 of them. ANA is also one of the criteria and so are antibodies against dsDNA and Sm antigens besides other lab test like complete blood count, anti phospholipid antibody and RPR. So based on your symptoms and lab tests, you meet 3 of these 11 criteria; 2 clinical, namely photosensitivity and malar rash and 1 laboratory i.e positive ANA (does'nt matter if its within normal limits because this does'nt exclude lupus). Therefore other tests need to be carried out in order to establish the diagnosis and define prognosis.
Besides being specific for lupus, dsDNA is also a Lab test of certain prognostic significance. A high antibody titre against dsDNA indicates a poor prognosis and renal involvement that requires aggressive measures. Similarly renal involvement can be predicted with other lab tests urinalysis and serum creatinine and Blood Urea Nitrogen (BUN).
Yes, lupus is a great imitator and that itself is an indication for more specific lab tests!!
A rheumatologist would also rule out other diseases with joint involvement like rheumatoid arthritis which is all the more relevant specially since you have a low titre of ANA.
Regards
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
