Hi. I have a similar situation as you. I've always tested positive for rheumatoid factor, but negative for ANA. I have an official dx of RA, not SLE. And I will NOT be dx with SLE unless my ANA shows positive, along with the antibodies that are specific for SLE. My rheumy simply refers to it as my possibly developing rhupus ( a crossover between RA and Lupus, or possibly the beginning of MCTD--with MCTD, you never test positive for the specific lupus antibodies, but will eventually develop RNP antibodies--something like that). It simply requires monitoring; tx is similar for both, but there are certain RA drugs that may work better for SLE and vice versa. For example, plaquenil is the mainstay of tx for SLE, but it is also used for RA. I do take plaquenil in addition to some other DMARDs. I may never fully develop SLE, but I'm "on notice" for it, and I'm kind of being treated for it anyway. My rheumy often reminds me that it is more important to be treated for the actual sx, than to have a diagnostic label. He's fully aware of my past reactions to certain drugs (i.e., sulfasalazine), which can be indicative of SLE, so he simply avoids prescribing anything that can potentially aggravate SLE type sx.
The ultracet is better than nothing. I didn't want to move on to a narcotic, like vicodin, although I've had days where it's been tempting. Rheumy has never offered a narcotic, and I don't think he would unless I brought it up first. I simpy stayed with the ultracet and prayed that the enbrel and mtx would kick in. If I have a day that's really bad, I just deal with it. I haven't had debilitating pain for a long time. Now that the enbrel and mtx have kicked in, my bad days are getting less and less, although when the enbrel injection wears off towards the end of the week, I feel like I could take a few more ultracet. My insurance gives me a hard time about taking the few ultracet I currently take (I only take 4/day--rheumy prescribed 6/day). I choose not to push the envelope.
Both the RF and ANA are implicated in several different autoimmune diseases, and both can be found with RA. You only need to be positive for RF to get a dx of RA (in addition to the overall clinical picture), and many normal and healthy people have a positive ANA--especially low positive. Many healthy people also have a positive RF, but usually they are elderly people. My rheumy told me he doesn't typically test for the more specific ANA antibodies, like RNP, the DSNA, etc.... unless the overall ANA is positive. He did test me for anti-jo antibodies without a positive ANA, but predicted it would be negative. He was right. In any case, I wouldn't hang your hat on any specific labs--labs come back positive and then negative later all of the time. It is very confusing. Any rheumy worth his/her salary is not going to depend on just labs, but will take into account the whole picture. It sounds like your rheumy is doing that--he's aware of the pleurisy, pericarditis, and vasculitis.
What was your issue with the mtx? If it was nausea, I understand that it is available in injection form so it will bypass your stomach. I've noticed that I have no appetite for a few days after taking the mtx, and I'm only taking the starting dose right now--7.5 mg/week. I'm sure rheumy is going to increase it. If i start getting terribly nauseous, I'll ask about the injections. I've been sick a lot since on the enbrel as well. I suppose if infections turn into chronic conditions I will probably have to stop taking it. So far, though, my infections have been self-limiting (except for my current sinus infection) and have resolved with antibiotics. You definitely don't want to take any of the biologics with a heart condition. Are you seeing a cardiologist for that? It's possible that you could be developing SLE, but it could be a case where you never fully develop it. These diseases often take a long time to fully evolve. I still think it's more important to take care of the sx and get your pain under control. Can you take NSAIDS at all? i suppose many of us cannot tolerate them. Perhaps you should consider getting a bit more assertive with your rheumy and ask for something more. Narcotics, though, will not help you in the long run; they do nothing for inflammation.
I hope you feel better soon,
just to add, i also suffer frequent bouts of pleurisy, and just recently vasculitis in the lower extremities and has a few years ago pericarditis which damaged many valves in my heart. this was all RA and inflammatory related in this case.
so it is possible.
a good diagnostician who sees the whole picture is a great asset.