Diagnosis Jitters

Now that the clock is ticking down on my appointment with the rheumatologist now that the fabulous Dr. H has sent my referral, I've been trying to think through what's going to happen next week when I meet with this new guy, whom the fabulous Dr. H says is really damn good.  He's obviously going to want to run more tests, as I have not had my complement levels or anything like that done.  But will he go ahead and tell me that I have SLE?  That's the question.  I've spent a lot of time over the last few days trying to figure that out.  

Okay, so the American College of Rheumatology set up eleven criteria for diagnosing someone with SLE.  Usually, depending on which ones you have, you only need four for your doctor to make the diagnosis: 

1. Malar rash: butterfly-shaped rash across cheeks and nose
2. Discoid (skin) rash: raised red patches
3. Photosensitivity: skin rash as result of unusual reaction to sunlight
4. Mouth or nose ulcers: usually painless
5. Arthritis (nonerosive) in two or more joints, along with tenderness, swelling, or effusion. With nonerosive arthritis, the bones around joints don’t get destroyed.
6. Cardio-pulmonary involvement: inflammation of the lining around the heart (pericarditis) and/or lungs (pleuritis)
7. Neurologic disorder: seizures and/or psychosis
8. Renal (kidney) disorder: excessive protein in the urine, or cellular casts in the urine
9. Hematologic (blood) disorder: hemolytic anemia, low white blood cell count, or low platelet count
10. Immunologic disorder: antibodies to double stranded DNA, antibodies to Sm, or antibodies to cardiolipin
11. Antinuclear antibodies (ANA): a positive test in the absence of drugs known to induce it. 

So, in general, you only need four, and you should have more than one symptom at a time, if I understand things correctly, and some symptoms are more symptomatic than others.  Which ones have I had?

4.  Mouth or nose ulcers: usually painless
5.  Arthritis (nonerosive) in two or more joints, along with tenderness, swelling, or effusion.
6.  Cardio-pulmonary involvement
11.  Antinuclear antibodies (ANA)

 But those are the only ones I know I've had without any other explanation.  To be honest, I've had #9,  a funny liver enzyme test (while I was having gall bladder attacks) and I had #8,  protein in my urine (when I had the worst bladder infection in the world.)  Both of those, however, might have a perfectly logical explanation, as listed before.    

In addition, I have been treated 2-3 times for what everyone has assumed were patches of ringworm on my forearms.  As it turns out, those patches look a LOT like discoid lesions, and we treated them with steroid cream and they went away.  So, have I had symptom #2?  Maybe. 

So, it really is a judgment call.  I can't tell what my rheumatologist is going to decide based on my chart and if he thinks my canker sores are enough to count as a symptom.  It's going to come down to the bloodwork, I think, and what he makes of that weird lupus antibody test I had.  It didn't come back positive for any of the hallmark antibodies mentioned in #10.  But I did have anti-centromere antibodies. 

So much for trying to out-diagnose the rheumatologist.  I'm just going to have to sit tight and hear what he says.