instruction: hello doctor I am 57 years old with extreme fatigue achy joints in hands and feet especially during the first hours in the morning or after resting I have psoriasis in hand elbow leg and behind one ear and vitiligo over 80 of my body I get random low grade fevers and develop rashes when in sun and at times I will have the butterfly rash on my face I did not get a follow up appointment with my rheumatologist until next month any recommendations with what I should ask or discuss would be greatly appreciated I have attached my most recent labs and concerned with the results of the dna is all other lab reports are normal and negative is lupus a possibility I am currently taking prednisone 10 my synthroid 125 advair 100 50 and zyeartec 10mg
output: hello I have gone through your reports considering the symptoms and medications you are taking I would like to know a few more details how is the sleep pattern do you get enough sleep or is it disturbed any early morning fatigue any dryness of eyes or mouth do you experience any joint swellings any recent history of irritability any forgetfulness which has developed recently as per the investigations and ongoing treatment my suggestions would be didna has not much relevance in your case it looks like a false positive value mainly cause ana is negative and ear and cop are normal you are on too high dose of prednisolone which is not good for bones and psoriasis as well we need to cut down on the dosing methotrexate may be a good option as psoriasis can cause a lot of joint pains itself which will get better with it also it is a good drug for removing steroids