A lot of rheumatologist, expect patients signs and symptoms and labs to meet all the criteria or check all the boxes like in a textbook case. That leaves a lot of patients, undiagnosed and untreated because few of us are textbook cases. The doctors seem very reluctant to diagnose these auto immune diseases. That results in unnecessary and prolonged suffering for patients who just need relief and appropriate treatment. It took me 10 years to get diagnosed simply because my classic lupus symptoms preceded laboratory evidence of lupus. it’s not unusual for symptoms to precede lab evidence, but you have significant positive lab evidence. It should not be ignored just because your DSDNA is at an equivocal titer. That titer can change and if you tested that antibody 10 times you might get 10 different levels. someone has to use some common sense here. I do hope a second opinion yield some answers, a diagnosis, and a successful treatment plan for you. There are way too many people in the same boat experiencing your dilemma.