question: Hello doctor, I am currently struggling with a flare that is just not getting better. My symptoms started three years ago. At that time my ANA was high positive, lupus anticoagulant positive, but nothing else specific. My symptoms are joint pain, swelling, severe fatigue, severe hand swelling, severe Raynauds, GERD, nausea, constipation, dysphagia, eye swelling, occasional strange rashes from sun, and muscle weakness. My ANA is high positive, speckled. RNP, chromatin ab, and RNP (but anti smith is negative?) are positive. Scleroderma, anti-DNA, and Sjogrens ab's negative. I also have Hashimotos but the thyroid is functioning fine. I was recently put on Prednisone 10 mg daily. My doctor is not increasing the dose because of psychological side effects. I have an eye exam to start Plaquenil this week. My joint pain and GI symptoms are now under control. I am now struggling with limb weakness, muscles burning (like I am lifting weights). I am unable to work and live completely independently because of it. When my doctor assessed muscle strength she said it was abnormal (4/5 against resistance, lots of muscle shaking). My ESR and CPK were normal but I was not experiencing muscle issues at the time blood was drawn. I am getting more labs done and will possibly be referred to a neurologist at my next visit in a few weeks. My question, based on the positive labs and symptoms, what diagnosis is likely? She has said both UCTD and MCTD, not lupus because of the symptoms. What is your general opinion? And out of curiosity, what is the difference between RNP/sm and sm ab? My current medications are Prednisone 10 mg QD, Cymbalta 60 mg QD, Flexeril 10 mg QHS, Naproxen BID.