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.
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).
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Published On: October 12, 2006