What is the best confirmatory test for lupus?

Question

Hi doctor,

I am a 37-year-old Hispanic female. My symptoms began one year ago, and the headaches began two months ago. The positive lupus test was a month ago when I was hospitalized. I want to speak to a rheumatologist regarding a possible lupus diagnosis. I was hospitalized a month ago with severe headaches in the back of my head that have been ongoing for two months. My ESR inflammation rates were 103. The doctors at the hospital placed me on Prednisone, and I have been taking it for a month now. During the stay at the hospital, they did an MRI, CT scan, and spinal tap, which were all negative. The only positive test was the lupus anticoagulant silica clotting test. For the past year and a half, I have had severe fatigue, joint pain, and a rash on my chest that lasted six months and then disappeared. Hair loss, severe daily headaches, and on-and-off chest pains. I believe I have all the symptoms of lupus; however, I cannot see a rheumatologist in my town until September. I need to make sure I am on the right course of treatment and what I can do because the neurologist at the hospital put me on Prednisone to treat me for possible vasculitis that may be due to lupus. I have not gotten a definitive diagnosis from anyone so far, and all I have is the positive lupus test. My fatigue is severe, and my headaches do not respond to pain or migraine medications. It feels like severe pressure in my head, an exertional-type headache. I need some guidance and a possible diagnosis on what to do. I had a second ANA test two weeks after the positive lupus anticoagulant, and it was negative. So I am confused about my diagnosis. Kindly help.

Answer 1

Hi,

Welcome to icliniq.com.

I went through your detailed post. Your chief complaint was a headache with a very high ESR (erythrocyte sedimentation rate), seen only in a few conditions, such as giant cell arteritis. However, a temporal artery biopsy should have been taken before putting in Prednisolone, which would have confirmed the diagnosis. You do not have lupus features associated with arthritis, oral ulcers, photosensitivity, and malar rash. However, you have many abnormalities in your blood profile; without further discussion, it is difficult to assist you.

Thank you.