Well, it is very rare to have sero-negative lupus but not impossible. Sero-neg Rheumatoid Arthritis is more common than SLE, but still pretty rare. In most cases where people present with symptoms before positive lab work, something will show up later on. Some lupus patients are ana-neg but diagnosed with lupus nephritis through a kidney biopsy. So just because you arent showing the AI markers doesnt mean it isnt doing damage to your organs yet. I'm assuming if you went to Duke they looked for the uncommon antibodies too. Also, Adult Onset Stills disease is something I've been tested for before my ANA's started popping consistently pos. It presents with daily fevers, urticaria-like hives, and joint pain. It doesnt show up on the normal AI work up...takes a little digging and a lot of ruling out to find. But if you have exhausted all ideas maybe its worth mentioning and looking into. I hope the knowledge fairies sprinkle smart dust all over your doctors Good luck getting some answers. Trying to diagnose my AI issues was/is harder than diagnosing my dysautonomia!