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Moderate systemic Hypertension.

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I am a 39 year old hispanic male. History of high blood pressure (currently taking toprol xl and lisinopril) and IBS (currently taking prevacid and elavil). I have also been diagnosed with fatty liver. Last month I was diagnosed with the flu at the hospital - worst case I have ever had. After my recovery I started getting ankle pain and a little wrist pain. Over the course of a few years I have noticed that my face tends to have a blushed look - small areas of redness over my cheeks. Admittedly I'm a hypochondriac and have panicked over diseases from a very young age. I went to the doctor for a follow up - I have pretty high cholesterol but I noticed that I also had trace amounts of protein in my urine. I am currently very afraid that I have lupus. The doctor's office called me and said my results were fine. I was embarrassed to bring up lupus since I do worry a lot. My ALT was slightly elevated but I believe I've had that in the past because of the fatty liver. I don't know what to do. Should I see another doctor? Am I overreacting again? Please help.

Category: Rheumatologist

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Category: Internal Medicine Specialist
 27 Doctors Online

Hello and thankyou for approaching DoctorSpring with your query.
I have gone through your case and understand your concern.
It is unlikely that you have systemic lupus erythematosus. (SLE)
ALT elevation is non specific, and will only require a follow up of the test in 4 months.
SLE can be diagnosed clinically based on symptoms. Please can you give me additional information so that I can advise you accordingly.
1) Do you have any fatigue, weight loss, muscle pain or fever with no apparent infection or other cause?
2) Do you have hair loss, mouth ulcers?
3) Do you have sensitivity to sunlight or do you have rash on both your cheeks that goes over your nose?
4) Do you have any swollen lymphnodes?
5) Do the same joints pain at all times? is there any redness swelling or increased temperature of your joints?
6) Does your skin have patchy skin color, or do your fingers change color when they are cold?
7) Any frequent abdominal pain, nausea , vomiting?

Please reply as a follow up and I will guide your accordingly.

Patient replied :

What about the trace protein found in the urine? Is that of concern?
I have some fatigue, no weight loss, no muscle pain or fever.
No hair loss or ulcers.
I do have a light reddish blush on my cheeks but not going over the bridge of my nose.
No swollen lymph nodes. I have had pain in my right ankle and right wrist but I do not think they are swollen. The pain seems worse in the morning and then gets better. The ankle pain is something I have had on and off for many years. The wrist pain is new. My hands do get cold but my fingers do not turn white or blue. They tend to be red when I stretch my hand. No abdominal pain, nausea or vomiting.

Hello and thankyou for answering my questions.
I have gone through them. You have no signs or symptoms suggestive of SLE.
The trace protein found in your urine is non specific as it can be present in normal individuals, due to exercise, prolonged standing, stress, fever, cold or heat exposure.
Your symptoms are not suggestive of a rheumatology problem. Besides SLE is less predominant in the males.
However I would advise you to consult your family physician periodically and get examined.

You can get tested for Anti nuclear antibodies (ANA test) as a screening test to rule out SLE . Discuss this option with your doctor so that you can get tested and rule out SLE which will give you peace of mind.

I hope this has helped.
Wishing you good health.

Patient replied :

I am embarrassed to go to my doctor. You do not think I need to see a rheumatologist? I'm sorry.


At this stage I do not think you need to see a Rhuematologist. Give some time. 4-6 weeks, If the joint pains persists at the time you can discuss with your GP and consider a Rheumat visit. Do not worry, you are very unlikey to have Lupus.

Let me know if you have any more queries.
Thank you

Patient replied :

I did have a follow-up examination and an ANA test run, CRP and a few other tests that all came back negative. However, I did have very low vitamin D which I am correcting now. Unfortunately it doesn't end there as I started having some issues with my right eye. The opthalmologist said it's a cotton wool spot that he thinks may be related to my blood pressure (I am on BP medication for several years). Of course I am concerned about Lupus again since I know this can be a symptom. The pain in my ankle and wrist have subsided but now I have this new symptom. Is it possible that I tested ANA negative while I was having ankle and wrist pain but still have lupus? I just keep putting all of these symptoms together in my head - joint pain, cotton wool spot, trace protein in urine, cold hands and feet and what seems to be poor circulation in my feet.

Admin Message -

Your consult has been closed - Either you have utilized more than 3 follow-up queries or your consult is now older than 1 month. I request you to initiate a new consult. You could consult the same Doctor as well, please mention the same in the new consult with reference as 147816.

Hope this communication was fruitful. Wish you good health.

Thank you
In-house Physician

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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