I have positive ANA of 40. Just went to Rheumatologist yesterday. He did labs. Waiting for results. I have all the symptoms of Lupus from what he said. However, I don't have the facial rash. Extreme fatigue, headaches, muscle and joint pain. Evenings are the worst. None are completely incapacitating at this time, except the fatigue. Getting a diagnosis for this stuff is crazy. I've been seeing family doctor for 2 years with these complaints. They did a Liver biopsy and confirmed Primary Biliary Cirrhosis. I don't know enough about either disease to know what to do. Makes me feel like I'm crazy. I've always been very active and am finding that increasingly difficult to continue. How do you ever get a firm diagnosis?