Ask the Expert: Diagnostic Tests for Muscle Swelling, Rash and El

Mark Borigini, M.D. Health Pro
  • Question: Hello, I am a 47-year old female who has not yet been diagnosed with any condition, although I do have an upcoming appointment with a rheumatologist. I have severe swelling in most of the muscles in my body, especially on the left side. I can feel huge knots and swelling, and sometimes I have a terrible rash that accompanies the pain, which covers a large part of my arms. I have now started having terrible, terrible back pain, and sometimes feel as if I am unable to function because the pain is so severe. At the same time, sometimes I can go for days at a time with only a small amount of pain. As a general rule, my white blood count goes up. My doctor says I have an autoimmune disease, but cannot diagnose exactly what it is. It has been discussed that I may possibly have lupus. Can you suggest anything to help me identify what may be going on? I have had this severe problem for approximately a year, although some symptoms occurred at a younger age. Any comments would be welcome.
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    Dr. Borigini: If there is truly swelling in the muscles, and no explanation for it, if there are no contraindications, your doctor might consider a muscle biopsy. But I feel that a rheumatologist first must perform a thorough examination. If there is a persistently elevated white blood cell count, then perhaps, too, an evaluation by a blood specialist is in order.

    While one can see a rash in lupus, muscle swelling and an elevated white blood cell count are not part of the eleven criteria for the diagnostic classification of lupus.

    Finally, anytime a patient is experiencing unusual symptoms that cannot be explained easily, one must always be concerned about the possibility of an associated malignancy. At the very least, an age-appropriate cancer screening should be performed (such as breast and pelvic exams, and mammogram).

    Important: We hope you find this general medical and health information useful, but this Q&A is meant to support not replace the professional medical advice you receive from your doctor. For all personal medical and health matters, including decisions about diagnoses, medications and other treatment options, you should always consult your doctor. See full Disclaimer.
Published On: October 12, 2006