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Hi there,

I have a family Hx of SLE (my father). His c/c are dermatitis and DVT.

My PMHx: 5 years old patientof fatigue (?undiagnosed sleep apnoea), depression/anxiety (related to my work), and chronic (2 year) pain in my right Hallux metatarsal joint #1, which flares up every couple of days or so.. radiography shows no abnormalities and CT-guided cortico had no affect. I also have a twitch every day that happens in various parts of my body. 

No allergies.

Otherwise healthy.

I do not drink or smoke. 

Last week I had serology for lupus: ANA,SMA, ENA, ds-DNA, C3 & C4 antibodies.

Today I flew out to a remote location for work, and I am unable to easily see my doctor for about 15 days.

I spoke with the nurse at the clinic before I jumped on the plane and she stated that all tests were negative, apart from the Smooth Muscle Antibodies (SMA), and the ?Cytoplasmic Antibodies. These came back positive..... (not sure which tests were for the cytoplasmic antibodies, best guess is C3 &C4?)

Additionally I have been taking Testosterone enanthate 300mg IM every 4 days, and Nolvadex (Tamoxifen) 20mg po 1 bd. Both for the last 3 weeks, and 1 day. (1st time using for aesthetics...)

My main question is this......

Would it be prudent of me to stop the anabolics (testosterone) and the oestrogen blocker (Nolvadex) immediately due to my recent test results (SMA & Cytoplasmic antibodies) ???

How will taking the Testosterone and Tamoxifen affect the SMA and Cytoplasmic antibodies? (risk v. benefits?)

I will see my doctor in two weeks. What should I do from here? What tests should I request from my general practitioner?


Category: Rheumatologist

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Category: Internal Medicine Specialist
 29 Doctors Online

Thank you for your query at
I have few questions before I can answer your questions.
Why are you on anabolic steroids and tamoxifen?
What is the method of ANA test conducted on you. If it is by immunofluorescence can you mention the reference range and the titers? Can you also send the titers for SMA & Cytoplasmic antibodies?
Your pain at hallux valgus can be gouty attack. Please check serum uric acid between attacks.
You are 24 years. Are you obese to have undiagnosed sleep apnoea?
Kindly get serum Vit D3 vit B12, serum ferritin, TIBC, ESR TSH and CRP before interpreting ANA.
I need these reports for further management. So kindly get the tests done and upload the reports,

Patient replied :

Hi there,
Please find the laboratory results below. Hopefully they can shed some light on method of the tests.
Yes, I am overweight at 105kg, but I am fairly fit and muscular, but do have an amount of fat.
I am taking the tamoxifen for gynogcomastia, the testosterone for ?low levels.
I am unable to get those other tests (Vit D3 vit B12, serum ferritin, TIBC, ESR TSH and CRP) for two weeks.

As at 9/10/2014.
Test name: SE-C3 C4
C3c 1.14 g/L (0.9-1.8)
C4 0.27 g/L (0.1-0.4)
Test name: SE-RF
RF <10 IU/L (<14)
CRP 1 mg/L (<5)
Antinuclear Antibodies (ANA) Negative (Titre <1:80)
Mitochondrial Antibodies (AMA) Negative (<1:20)
Smooth Muscle Antibodies (ASM) Moderate Positive (titre 1:80-1:320)
Anti-DNA (FEIA) <7 IU/mL (<10)
Antinuclear Antibodies (ANA) Negative (Titre <1:80)
Cytoplasmic Antibody Detected
An antibody to a cytoplasmic antigen has been detected.
Suggest anti-smooth muscle and anti-mitochondrial antibodies if
clinically indicated.
Test name: SE-_ENA VIRTUAL
Extractable Nuclear Antigen (ENA)

ENA Screen Not Detected

ENA Characterisation Line Assay
Comments on Lab Id:437838857
ENA screened by Elia for Sm, U1-snRNP, SS-A/Ro60, SS-A/Ro52, SS-B/La,
Scl-70, Jo-1, PCNA, Ribo-P, PmScl-100, CENP, Fibrillarin,
RNA Polymerase III, Mi-2.

Thank you for the additional information.

Low titres of some autoantibodies are not of clinical importance in any setting.
For gynaecomastia, the best option is surgical removal. Excess weight causes your testosterone to get converted to estrogen in the fatty tissue of your body leading to gynaecomastia and even weakness in muscles as your muscles require testosterone for its anabolic activity rather than estrogen.
Please also understand that testosterone injections given to any overweight/obese individual may not be a good idea as it may produce undesirable side effects like fatty liver, hypertension, liver tumor formation, more weight gain due to conversion into estrogen etc.
For this reason, I would suggest that you get off the testosterone shots.
Please discuss this with your endocrinologist in detail.

The best treatment for you is weight loss which will solve almost all your issues.

In my opinion, low levels of any auto-antibody is considered to be normal until and unless there are clinical symptoms and signs of good strength which is not the case here.
Please also get your serum uric acid levels as suggested earlier.

Let me know if I can assist you any further.


Dr. Bimlesh Dhar Pandey
Category: Internal Medicine Specialist
Senior Residency: Rhematology, All India Institute of Medical Schiences, New Delhi, 2009
Post Graduate, Junior Residency: MD (Internal Medicine), Rajendra Institute of Medical Sciences, Jharkhand, 2006
Residency: Physiology, Institute of Medical Science, Banaras Hindu University, Varanasi, 2003
Internship: Government Medical College, Trichur, 2001
Medical School: MBBS, Calicut University, 2001
Dr. Bimlesh Dhar Pandey and 4 other Medical Specialists are ready to help you

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