question: Hi doctor, For the past one year, I have been having bouts of urticarial vasculitis with lumps under skin on upper arms which turn to large rusty red areas before bruising yellow and fading away. The rash is transient and moves around the body across thighs, etc. My knees go red and there is a blue swelling. I am having low grade fever and malaise. Now the fingers next to thumbs on both hands are turning in with pronounced bony lumps on the fingers on the joints nearest the nails. Neck gets stiff and elbows have red areas too. I have feeling in the chest though seems to be asthma related apparently. My ESR and CRP are normal, but I have eosinophilia. My liver and kidney functions are fine, but alkaline phosphatase is borderline high. I have confirmed vitamin D deficiency and osteopenia. I have raised anticardiolipins since mid twenties and it never become normal. Can you help? My paternal grandmother had Paget's disease and rheumatoid arthritis. Low C3 and C4 have been identified in my son and also with my nephew. Currently, I am taking Venlafaxine for symptoms of menopause.