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The positive ANA at 1:640 titre is the reason why you need to continue to see the rheumatologist. You should also see a dermatologist about the rash you describe. These trained specialists are the ones that will be able to diagnose you, and treat you.

The bigger reason you should do these things is because it is quite likely you have some sort of autoimmune disease that is NOT being treated. Without treatment, you won't get better. In fact, without treatment it is likely you will get worse. With treatment, there is a good chance of some improvement.
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