Q: My 30 years old wife weighs 52 kg and has been suffering from low-grade fever, moderate joint pains and skin rashes for the past two years. Her ANA has come out positive, DsDNA - negative and all TB tests negative. Her erythrocyte sedimentation rate (ESR) has been consistently very high ranging 100-130. She has lost 20 kg in the last two years. She has been on hydroxychloroquine sulphate (200mg) B.D. and some steroids. When she takes steroids her condition improves, ESR goes down but she develops diabetes. Why is HCQS (hydroxychloroquine sulphate) not showing any positive results?

A:The history of joint pains, rash, fever and high ESR are quite suggestive of a collagen vascular disorder. She can be re-evaluated since initially some of these disorders may be undifferentiated but later fall into one of the syndromes categories. She can repeat DsDNA, ANA-LIA, Vasculitis-LIA panel to see if any of the other collagen markers are positive. She can be started on other steroid sparing agents provided she is not planning a pregnancy. Hydroxychloroquine is a mild agent but a safer option in young women. You need to urgently consult a rheumatologist.