I have multiple autoimmune conditions already diagnosed. Multiple doctors now believe there is an additional one at play. Work is being done to narrow a diagnosis; and I am looking for help and suggestions. Forgive the lengthy history; but I am really in need of some experienced input. At 10y.o. I was diagnosed with Type I Diabetes. It is confirmed autoimmune. At 19 my joints began to swell and I developed pyoderma gangrenosum. At that point my ANA /SED/Etc were all negative. I was brushed off with a dx of osteoarthritis. At about 28, my colon stopped functioning (colon inertia) and was removed. Pathology came back as simple colon inertia even though my surgeon told me it was covered with lymph nodules (as was my entire GI tract inside and out, worst thing he ever saw he reported). Six months after that surgery, Pegasus testing came back high positive for both Crohn's and Ulcerative Colitis but biopsies were still negative. 5 years later, Crohn's DX. Along with the Crohn's DX, severe joint symptoms once again, still a negative ANA, but DX of Hashimoto's Thyroiditis (lab was 13.5x the high indicator level). Trigger fingers DX. Joint survey x-rays were done, all clear. Also at this time, DX of MGUS with no M-spike but abnormally high flc ratio. (Hematology consult gave dx of MGUS, then a few years later said perhaps it is not true MGUS but a severe autoimmune spike?) In the past year, previously DX trigger fingers now turning to clawing of hands and also feet. Hand joint x-rays are now scarred and show adhesions and triggere fingers but docs have noted no shiny skin hallmark of scleroderma. Currently, positive ANA 1:320 and CRP elevated to twice the high normal indicator. ANA titer additional test panel all negative. SED rate normal. During ALL previous problems since 19y.o., joint problems, skin issues, Fibromyalgia DX, Chronic Fatigue DX; referred for MS work-up by 3 different providers (Neuro consults disagreed and said that while diabetic neuropathy did not cover all nerve issues, they believe it is "other than MS"). Have also been dx at different points with Hepatomegaly, Splenomegaly, Cardiomegaly; scarred lungs and restricted flows on PFT with 40-60% function variably, esophageal dysphagia and gastroparesis with Barrett's on gross inspection that turned out to be completely benign/negative upon biopsy, Sicca Syndrome. I have a hx of hallucinations/ other neuro symptoms. I have also suffered with anesthesia-induced autoimmune encephalopathy. Many other strange health issues: mouth sores, chronic migraine with aura, joint pain (large and small), stiffness, flat back syndrome, trigger fingers, total body tendonitis/tinosinovitis (sp?), and others too numerous to list. Have seen a geneticist who "had never seen this much autoimmunity in one family" in their entire career. Every doctor I have seen for any reason (surgeon, PCP, etc) have all stated that I have at least one thing they have never seen in their career. I have been sent for work-up for Lupus/RA suspect 6 times (this is my first positive ANA, even with other confirmed AI) and also the MS work-ups and Crohn's work-ups. Family History of *T1D, Lupus, MS, Down Syndrome, Osteomyelitis, Psoriasis, *pyoderma gangrenosum, *Rosacea, *Hashimoto's Thyroiditis, *Crohn's, Ulcerative Colitis, Dysautonomia (both diabetic related and idiopathic), *Encephalopathy, Epilepsy possibly others I have forgotten. I am seeking a rheum. referral;but in the area where I now live you must come to them WITH a dx. They do not make dx, they want one already in place from your PCP. I have no idea what to tell them nor does my internist. I am seeking suggestions on similar patient scenarios, lab recommendations, imaging recommendations (cannot have MRI due to implant). Grateful for any help or advisory commentary!