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What Do Swelling In Legs And Ankles Along With ESR Level Of 37 Suggest?

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Posted on Thu, 25 Jun 2015
Twitter Thu, 25 Jun 2015 Answered on
Twitter Wed, 15 Jul 2015 Last reviewed on
Question : I have been swelling in my legs, ankles and feet for several years for an unexplained reason. I had a lot of labs and done recently. My ESR has been as high as 37 over the last few years, but normally in the low 30s (now 28). My ALT goes up to about 70 but is currently 38. My ALT is sometimes slightly elevated. I had a rheumatoid factor test recently that is negative but ANA is moderately positive. No ANA titer was done. Anti DS DNA AB test was negative. Eosinophils are slightly low. GFR estimated from 24-hr urine was 118. Creatinine clearance was 187, but I'm told that as long as the GFR is good overall, the creatinine clearance doesn't matter. There is almost always trace to high blood in my urine and occasionally protein (no protein on my recent 24-hour urine test. WBC has been low for several years and is never normal, now 3.9. Chloride is 99. What could cause all this? The swelling is at the point where it's starting to affect my life. I have to come straight home and elevate my feet after work. I sleep with my feet above my heart level, but often they are still swollen the next morning. I cannot lose weight, despite working out and cutting back on sweets and portion size. I've had a hysterectomy but swelling started well before that.
doctor
Answered by Dr. Dr. Shruti Rijhwani (1 hour later)
Brief Answer:
Lupus needs to be ruled out.

Detailed Answer:
Dear Madam,

Thank you for posting your query on HCM.

Well looking into your problem I would like to tell you that there is a fair chance of you having lupus with all these tests that you have provided . In my opinion you should be evaluated more on this line.

Get your ANA done by IFA method , ENA profile , complement levels c3,c4 , Coombs test , lupus anticoagulant assay .

Atleast this much will be require minimally for lupus . Also what about your thyroid status that you havent mentioned , this also needs evaluation.

Please mention if you have history of recurrent oral ulceration , photosensitivity, recurrent abortions or raynauds phenomenon . Also any other history which you feel is significant please share so that we can help you out in best possoble way .

Take care.

Dr. Shruti
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Shruti Rijhwani (12 hours later)
Six years to conceive before live birth of my daughter, then 2 ectopic pregnancies. During the second, I had preeclampsia symptoms with high protein in urine during the time that the ectopic was discovered. I am constantly feeling run down and my appetite is suppressed, although I gain weight. I have severe edema in my legs, ankles and feet and try to be in bed with feet elevated whenever I am not working. I also swell in my hands and arms during exercise and have swelling under the eyes and I feel bloated. I do get sore feelings in the back of my gums. Although they feel like sores, I cannot see them, so I'm not sure if they are sores. I often feel like I will pass out, especially when I stand. I'm often very dizzy, have severe headaches, and feel unwell overall. My doctor thinks that since my Anti DS DNA is negative, I don't have lupus. I don't have lupus in my immediate family, only a first cousin has it. My hands and feet are usually cold, but not to the point where they turn blue.
doctor
Answered by Dr. Dr. Shruti Rijhwani (41 minutes later)
Brief Answer:
Follows.

Detailed Answer:
Dear Madam,

Thank you for reverting back.

In my opinion there is a fair chance of lupus , Anti dsDNA signifies kidney involvement in lupus but its negativity doesnt mean that you cant have lupus . You should see a good rheumatologist for the same . One of your cousins have SLE that means there is more of reason to evaluate so please pursue it further and discuss this with your treating doctor .

Dr. Shruti
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Shruti Rijhwani (6 minutes later)
Thanks. I left out that the thyroid was checked further with ultrasound and T3&T4 tests, and all were normal.
doctor
Answered by Dr. Dr. Shruti Rijhwani (1 hour later)
Brief Answer:
Follows.

Detailed Answer:
Dear Madam,

Thats a good news that thyroid functions are fine , if you have any further queries let me know .

Dr. Shruti
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
Dr.
Dr. Dr. Shruti Rijhwani

Rheumatologist

Practicing since :2008

Answered : 2366 Questions

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What Do Swelling In Legs And Ankles Along With ESR Level Of 37 Suggest?

Brief Answer: Lupus needs to be ruled out. Detailed Answer: Dear Madam, Thank you for posting your query on HCM. Well looking into your problem I would like to tell you that there is a fair chance of you having lupus with all these tests that you have provided . In my opinion you should be evaluated more on this line. Get your ANA done by IFA method , ENA profile , complement levels c3,c4 , Coombs test , lupus anticoagulant assay . Atleast this much will be require minimally for lupus . Also what about your thyroid status that you havent mentioned , this also needs evaluation. Please mention if you have history of recurrent oral ulceration , photosensitivity, recurrent abortions or raynauds phenomenon . Also any other history which you feel is significant please share so that we can help you out in best possoble way . Take care. Dr. Shruti