This is my red face rash and my lovely dry cracking lips...
Anyway - Rheumy letter: I shall type it out in full:
Many thanks for asking me to see this 43 yr old lady who has a background history of possible ME.
Since October she has noticed pain in the small joints of her hands. She has also had back pain for the past 9 yrs but it seems slightly different now and she describes inflammatory sounding pain in her hips and lower back. She has the pain in the morning and it gets better. Equally when she stands for long periods the pain is worse. She suffered with glandular fever at the age of 18 and sine then she has been diagnosed with ME and feels very tired. She was involved in some research at Addenbrooke's at the age of 21 and did not respond well to steroid therapy in the research as there was a problem with her white cells at that time.
Mrs O also suffers with IBS, which mainly causes diarrhoea. She has had a colonoscopy in the past which was entirely normal. She feels her knees and elbows are weak but she doesn't get much pain in those joints. She describes very dry skin and she also has dry eyes. She used to suffer with jaw pain and a facial rash, like sun burn, but she denies any photosensitivity. She also denies any mouth ulceration. She has a flaky scalp and eyebrows. She is not on any regular medication at present.
Mrs O works as a self employed web designer. She has 2 children and no history of miscarriage. There is a family history of autoimmune disease, including coeliac disease in her nephew, rheumatoid in her maternal aunt (it was actually my cousin - he died from it aged 7) and lupus in her aunt. Her father also suffers from what looks like Sjogren's syndrome.
On examination she looked well. There were no obvious skin changes suggestive of psoriasis. There were no features of active inflammatory arthropathy. She is very flexible in her spine and in her elbows. There were no features of peripheral arthropathy. Sacroiliac and hip joint examinations were normal.
I have arranged an x-ray of her lumbar spine and sacroiliac joints and will see her again in my clinic in approx. 3 months.
What do you think? I felt very deflated when I read it... The GP surgery told me the renal profile bloods and ESR were normal, no further action... I feel like I am going to be discharged and back where I started. Am I being too negative? Do I need one of you to give me a slap and tell me to pull myself together?