Re: Question about lab results

[Guest guest]

,

Diagnosing rheumatic diseases can be tricky. I've listed many sites

for you to read and hopefully they will help you understand what these

tests mean. Have you had x-rays of your ankles to see if there is bone

erosion? Is there another rheumatologist that you can go to? DS DNA

AutoABS stands for Double Stranded DNA Auto Antibodies. A positive

double stranded DNA test strongly suggests a diagnosis of SLE, but I

believe your ANA would also be positive for a definite lupus diagnosis.

I did include an article about ANA negative lupus.

Here are some sites that explain this antibody and the lupus tests.

Anti-ds (double-stranded) DNA antibodies. These are substances which

react to the material which makes up the genes found in cells. Double

stranded DNA also plays a key role in the growth and multiplication of

these cells. increased blood levels of antidsDNA antibodies are found

in about 70% of lupus patients, and found very infrequently in other

disorders. However, the dsDNA used in the test must be prepared very

carefully so that it does not contain single stranded DNA. Antibodies

against this single stranded DNA are commonly found in disorders other

than lupus, and can confuse the results of the test. Anti-dsDNA

antibodies are more commonly found in lupus patients whose disease is

active, particularly when the disease involves the kidneys or the

central nervous system.

http://www.mtio.com/lupus/lal_2.htm

dsDNA antibodies (1:10 or greater) are found in 50-60% of systemic

lupus erythematosus (SLE), 20-30% in Sjögren syndrome, 20-25% in mixed

connective tissue disease (MCTD), and less than 5% in progressive

systemic sclerosis (PSS). High titers of antibody to native (double

stranded) DNA are specific for SLE.

http://www.aruplab.com/guides/clt/tests/clt_a219.jsp#1147427

Does ANA-negative lupus exist? What other labs are helpful when

thinking of this diagnosis, and what if all of them are negative?

http://www.hss.edu/Professionals/Conditions/Lupus/Ana-Negative-Lupus-

Exist

Anti-dsDNA have also been found at low frequency (generally less than 5

percent), and usually in low titer and with low avidity, in patients

with rheumatoid arthritis, Sjögren's syndrome, scleroderma, Raynaud

phenomenon, mixed connective tissue disease, discoid lupus, myositis,

uveitis, juvenile arthritis, antiphospholipid antibody syndrome,

Grave's disease, Alzheimer's disease, and in autoimmune hepatitis.

An increased frequency of these antibodies have also been noted in some

otherwise normal individuals, particularly first degree relatives of

patients with lupus and some laboratory workers

http://patients.uptodate.com/topic.asp?file=dx_rheum/18305#4

Cardio CRP:

http://www.questdiagnostics.com/hcp/intguide/jsp/showintguidepage.jsp?

fn=TS_CardioCRP.htm

Another test to monitor inflammation is called the erythrocyte

sedimentation rate (ESR). Both tests give similar information about the

presence of inflammation. However, CRP appears and then disappears

sooner than changes in the ESR. Thus, your CRP level may fall to normal

if you have been treated successfully, such as for a flare-up of

arthritis, but your ESR may still be abnormal for a while longer.

http://www.labtestsonline.org/understanding/analytes/crp/test.html

I hope this helps,

a

On Apr 14, 2005, at 5:11 PM, tandarat wrote:

>

> Hey guys,

>

> Well, I saw the rheumatologist for the first time about a week ago,

> and suffice to say I didn't like him.  He kind of half listened to

> me, and then pretty much patted me on the head, told me I just

> needed more sleep, gave me a prescription for an anti-depressant

> to " help " me sleep, and sent me out the door.  When I was

> persistant, he finally said he'd run some more tests to rule out

> lupus.  He didn't even look at my ankles, which are quite swollen

> just around the joint.  He looked at my hands, manipulated my knees

> and wrists (which hurt a little, but not bad), and told me I didn't

> have rheumatoid arthritis.

>

> In any case, I have a question about the lab results.  I got them

> from my REGULAR doctor, who apologized for suggesting this guy and

> is having me go to Loma University for an evaluation.  Anyway,

> this is what I got.

>

> On 3-15, the original test, my ESR was 40 and my RF was 64.  On 4-8,

> about 3 weeks later, my ESR was 50 (up 10 points), and my RF was 133

> (more than doubled in 2 weeks).  My lupus analyzer was all negative

> EXCEPT for the DS DNA AutoABS (what is that, can someone tell me?)

> which was just over the normal limit at 5 (normal is <5).

>

> The one that is really confusing, to both myself and my doctor, is

> my CRP.  It is marked as normal at 1.33, however, this is in

> the " Very High " range for cardiovascular chart, and, on top of

> that, the " normal range " is indicated to be between 0.00-0.70. 

> Either way, this is high.  Could someone have hit the wrong button,

> or are we both reading this wrong? The cardio chart is completely

> different than the reference range, as well, so I'm assuming that is

> for generalized inflammation, as opposed to checking it from a

> cardiological standpoint.

>

> My next question is this.  If my ESR went up 10 points in 3 weeks,

> why would my CRP be normal?  What could cause this?  I would assume

> that if my ESR is rising, there would be at least a somewhat

> elevated CRP, even if my sed rate was leveling off or even in the

> process of dropping from a peak.

>

> Oh, and I'd like to mention that my REGULAR doctor did look at my

> ankles, and she said it looks an awful lot like RA, though she can't

> be sure.  It looks, and feels, like a water balloon was partially

> inflated right below the ankle bone, and some swelling just behind

> it between the bone and achilles tendon, though it isn't bad there

> at all.  No redness, and only pain if you start pressing on the

> joint itself, or if I'm walking or standing.  Sometimes I have mild

> discomfort even resting it, but not bad, and it gets better if I put

> it up.  This is on both ankles, but my right is definitely worse

> than the left.  Does this sound familiar to anyone?

>

>

>

>

>

>

>

>

[Guest guest]

,

Diagnosing rheumatic diseases can be tricky. I've listed many sites

for you to read and hopefully they will help you understand what these

tests mean. Have you had x-rays of your ankles to see if there is bone

erosion? Is there another rheumatologist that you can go to? DS DNA

AutoABS stands for Double Stranded DNA Auto Antibodies. A positive

double stranded DNA test strongly suggests a diagnosis of SLE, but I

believe your ANA would also be positive for a definite lupus diagnosis.

I did include an article about ANA negative lupus.

Here are some sites that explain this antibody and the lupus tests.

Anti-ds (double-stranded) DNA antibodies. These are substances which

react to the material which makes up the genes found in cells. Double

stranded DNA also plays a key role in the growth and multiplication of

these cells. increased blood levels of antidsDNA antibodies are found

in about 70% of lupus patients, and found very infrequently in other

disorders. However, the dsDNA used in the test must be prepared very

carefully so that it does not contain single stranded DNA. Antibodies

against this single stranded DNA are commonly found in disorders other

than lupus, and can confuse the results of the test. Anti-dsDNA

antibodies are more commonly found in lupus patients whose disease is

active, particularly when the disease involves the kidneys or the

central nervous system.

http://www.mtio.com/lupus/lal_2.htm

dsDNA antibodies (1:10 or greater) are found in 50-60% of systemic

lupus erythematosus (SLE), 20-30% in Sjögren syndrome, 20-25% in mixed

connective tissue disease (MCTD), and less than 5% in progressive

systemic sclerosis (PSS). High titers of antibody to native (double

stranded) DNA are specific for SLE.

http://www.aruplab.com/guides/clt/tests/clt_a219.jsp#1147427

Does ANA-negative lupus exist? What other labs are helpful when

thinking of this diagnosis, and what if all of them are negative?

http://www.hss.edu/Professionals/Conditions/Lupus/Ana-Negative-Lupus-

Exist

Anti-dsDNA have also been found at low frequency (generally less than 5

percent), and usually in low titer and with low avidity, in patients

with rheumatoid arthritis, Sjögren's syndrome, scleroderma, Raynaud

phenomenon, mixed connective tissue disease, discoid lupus, myositis,

uveitis, juvenile arthritis, antiphospholipid antibody syndrome,

Grave's disease, Alzheimer's disease, and in autoimmune hepatitis.

An increased frequency of these antibodies have also been noted in some

otherwise normal individuals, particularly first degree relatives of

patients with lupus and some laboratory workers

http://patients.uptodate.com/topic.asp?file=dx_rheum/18305#4

Cardio CRP:

http://www.questdiagnostics.com/hcp/intguide/jsp/showintguidepage.jsp?

fn=TS_CardioCRP.htm

Another test to monitor inflammation is called the erythrocyte

sedimentation rate (ESR). Both tests give similar information about the

presence of inflammation. However, CRP appears and then disappears

sooner than changes in the ESR. Thus, your CRP level may fall to normal

if you have been treated successfully, such as for a flare-up of

arthritis, but your ESR may still be abnormal for a while longer.

http://www.labtestsonline.org/understanding/analytes/crp/test.html

I hope this helps,

a

On Apr 14, 2005, at 5:11 PM, tandarat wrote:

>

> Hey guys,

>

> Well, I saw the rheumatologist for the first time about a week ago,

> and suffice to say I didn't like him.  He kind of half listened to

> me, and then pretty much patted me on the head, told me I just

> needed more sleep, gave me a prescription for an anti-depressant

> to " help " me sleep, and sent me out the door.  When I was

> persistant, he finally said he'd run some more tests to rule out

> lupus.  He didn't even look at my ankles, which are quite swollen

> just around the joint.  He looked at my hands, manipulated my knees

> and wrists (which hurt a little, but not bad), and told me I didn't

> have rheumatoid arthritis.

>

> In any case, I have a question about the lab results.  I got them

> from my REGULAR doctor, who apologized for suggesting this guy and

> is having me go to Loma University for an evaluation.  Anyway,

> this is what I got.

>

> On 3-15, the original test, my ESR was 40 and my RF was 64.  On 4-8,

> about 3 weeks later, my ESR was 50 (up 10 points), and my RF was 133

> (more than doubled in 2 weeks).  My lupus analyzer was all negative

> EXCEPT for the DS DNA AutoABS (what is that, can someone tell me?)

> which was just over the normal limit at 5 (normal is <5).

>

> The one that is really confusing, to both myself and my doctor, is

> my CRP.  It is marked as normal at 1.33, however, this is in

> the " Very High " range for cardiovascular chart, and, on top of

> that, the " normal range " is indicated to be between 0.00-0.70. 

> Either way, this is high.  Could someone have hit the wrong button,

> or are we both reading this wrong? The cardio chart is completely

> different than the reference range, as well, so I'm assuming that is

> for generalized inflammation, as opposed to checking it from a

> cardiological standpoint.

>

> My next question is this.  If my ESR went up 10 points in 3 weeks,

> why would my CRP be normal?  What could cause this?  I would assume

> that if my ESR is rising, there would be at least a somewhat

> elevated CRP, even if my sed rate was leveling off or even in the

> process of dropping from a peak.

>

> Oh, and I'd like to mention that my REGULAR doctor did look at my

> ankles, and she said it looks an awful lot like RA, though she can't

> be sure.  It looks, and feels, like a water balloon was partially

> inflated right below the ankle bone, and some swelling just behind

> it between the bone and achilles tendon, though it isn't bad there

> at all.  No redness, and only pain if you start pressing on the

> joint itself, or if I'm walking or standing.  Sometimes I have mild

> discomfort even resting it, but not bad, and it gets better if I put

> it up.  This is on both ankles, but my right is definitely worse

> than the left.  Does this sound familiar to anyone?

>

>

>

>

>

>

>

>

[Guest guest]

Hello -

I have to say that the road to diagnosis can be long and frustrating.

Unfortunately, there are no definitive tests for RA - seems more art

than science most of the time. I didn't like my first

rheumatologist either. In fact, I don't like the second one much

better!!! I had to learn to live with the ambiguity for several

years before I was " officially " diagnosed with rheumatoid

arthritis. I have since learned that this is a common experience

for those with autoimmune diseases, whose symptoms often overlap and

mimic each other. I know this might not ease your anxiety and

frustration, but hopefully you can find comfort from the members of

this online community.

in Fort Worth, TX

>

> Hey guys,

>

> Well, I saw the rheumatologist for the first time about a week

ago,

> and suffice to say I didn't like him. He kind of half listened to

> me, and then pretty much patted me on the head, told me I just

> needed more sleep, gave me a prescription for an anti-depressant

> to " help " me sleep, and sent me out the door. When I was

> persistant, he finally said he'd run some more tests to rule out

> lupus. He didn't even look at my ankles, which are quite swollen

> just around the joint. He looked at my hands, manipulated my

knees

> and wrists (which hurt a little, but not bad), and told me I

didn't

> have rheumatoid arthritis.

>

> In any case, I have a question about the lab results. I got them

> from my REGULAR doctor, who apologized for suggesting this guy and

> is having me go to Loma University for an evaluation.

Anyway,

> this is what I got.

>

> On 3-15, the original test, my ESR was 40 and my RF was 64. On 4-

8,

> about 3 weeks later, my ESR was 50 (up 10 points), and my RF was

133

> (more than doubled in 2 weeks). My lupus analyzer was all

negative

> EXCEPT for the DS DNA AutoABS (what is that, can someone tell me?)

> which was just over the normal limit at 5 (normal is <5).

>

> The one that is really confusing, to both myself and my doctor, is

> my CRP. It is marked as normal at 1.33, however, this is in

> the " Very High " range for cardiovascular chart, and, on top of

> that, the " normal range " is indicated to be between 0.00-0.70.

> Either way, this is high. Could someone have hit the wrong

button,

> or are we both reading this wrong? The cardio chart is completely

> different than the reference range, as well, so I'm assuming that

is

> for generalized inflammation, as opposed to checking it from a

> cardiological standpoint.

>

> My next question is this. If my ESR went up 10 points in 3 weeks,

> why would my CRP be normal? What could cause this? I would

assume

> that if my ESR is rising, there would be at least a somewhat

> elevated CRP, even if my sed rate was leveling off or even in the

> process of dropping from a peak.

>

> Oh, and I'd like to mention that my REGULAR doctor did look at my

> ankles, and she said it looks an awful lot like RA, though she

can't

> be sure. It looks, and feels, like a water balloon was partially

> inflated right below the ankle bone, and some swelling just behind

> it between the bone and achilles tendon, though it isn't bad there

> at all. No redness, and only pain if you start pressing on the

> joint itself, or if I'm walking or standing. Sometimes I have

mild

> discomfort even resting it, but not bad, and it gets better if I

put

> it up. This is on both ankles, but my right is definitely worse

> than the left. Does this sound familiar to anyone?

>

>

[Guest guest]

Hello -

I have to say that the road to diagnosis can be long and frustrating.

Unfortunately, there are no definitive tests for RA - seems more art

than science most of the time. I didn't like my first

rheumatologist either. In fact, I don't like the second one much

better!!! I had to learn to live with the ambiguity for several

years before I was " officially " diagnosed with rheumatoid

arthritis. I have since learned that this is a common experience

for those with autoimmune diseases, whose symptoms often overlap and

mimic each other. I know this might not ease your anxiety and

frustration, but hopefully you can find comfort from the members of

this online community.

in Fort Worth, TX

>

> Hey guys,

>

> Well, I saw the rheumatologist for the first time about a week

ago,

> and suffice to say I didn't like him. He kind of half listened to

> me, and then pretty much patted me on the head, told me I just

> needed more sleep, gave me a prescription for an anti-depressant

> to " help " me sleep, and sent me out the door. When I was

> persistant, he finally said he'd run some more tests to rule out

> lupus. He didn't even look at my ankles, which are quite swollen

> just around the joint. He looked at my hands, manipulated my

knees

> and wrists (which hurt a little, but not bad), and told me I

didn't

> have rheumatoid arthritis.

>

> In any case, I have a question about the lab results. I got them

> from my REGULAR doctor, who apologized for suggesting this guy and

> is having me go to Loma University for an evaluation.

Anyway,

> this is what I got.

>

> On 3-15, the original test, my ESR was 40 and my RF was 64. On 4-

8,

> about 3 weeks later, my ESR was 50 (up 10 points), and my RF was

133

> (more than doubled in 2 weeks). My lupus analyzer was all

negative

> EXCEPT for the DS DNA AutoABS (what is that, can someone tell me?)

> which was just over the normal limit at 5 (normal is <5).

>

> The one that is really confusing, to both myself and my doctor, is

> my CRP. It is marked as normal at 1.33, however, this is in

> the " Very High " range for cardiovascular chart, and, on top of

> that, the " normal range " is indicated to be between 0.00-0.70.

> Either way, this is high. Could someone have hit the wrong

button,

> or are we both reading this wrong? The cardio chart is completely

> different than the reference range, as well, so I'm assuming that

is

> for generalized inflammation, as opposed to checking it from a

> cardiological standpoint.

>

> My next question is this. If my ESR went up 10 points in 3 weeks,

> why would my CRP be normal? What could cause this? I would

assume

> that if my ESR is rising, there would be at least a somewhat

> elevated CRP, even if my sed rate was leveling off or even in the

> process of dropping from a peak.

>

> Oh, and I'd like to mention that my REGULAR doctor did look at my

> ankles, and she said it looks an awful lot like RA, though she

can't

> be sure. It looks, and feels, like a water balloon was partially

> inflated right below the ankle bone, and some swelling just behind

> it between the bone and achilles tendon, though it isn't bad there

> at all. No redness, and only pain if you start pressing on the

> joint itself, or if I'm walking or standing. Sometimes I have

mild

> discomfort even resting it, but not bad, and it gets better if I

put

> it up. This is on both ankles, but my right is definitely worse

> than the left. Does this sound familiar to anyone?

>

>

[Guest guest]

Thanks, a.

I actually have gone and read a few of the sites you mentioned in

this post already, and I read the ones you suggested earlier, but

putting them all together makes even more sense. Thank you. I've

gotten " stupid " in the last year or so, and it is frustrating. I

actually know someone with ANA-negative lupus, which she contracted

after a bout with lyme disease. I'm not sure if this rheumatologist

believes in it, though. The lab highly suggests retesting in 2-4

weeks to see if the anti-dsDNA has gone up or my ANA becomes

positive. I doubt he'll do it.

I also understand the CRP will go down faster than ESR, but if my

ESR rose 10 points in three weeks, does it make sense that the CRP

is still " normal " ? I also thought that RF rises when the disease is

more active...mine had more than doubled in that three weeks. I'm

still not sure if the N in the results is correct or not, since both

references for normal on the test were much lower than what mine

was. It just doesn't make sense to me, and, of course, I'm probably

not going to get an answer from this rheumy. I do know that a

couple of days before my appointment, I suddenly went through some

really severe muscle and joint pain. It only lasted a couple of

days, and was starting to get much better the day I went in, though

I was still pretty darn sore. This was the first time my hands and

feet were involved more than being stiff, and the area around my

joints in my knuckles swelled noticeably, and my knuckles were red.

I also had a reddish rash on my cheeks and nose, much like the one I

get when I'm outside too long, but much larger, covering my entire

cheek and nose, rather than just the upper portion of my cheek and

maybe the bridge and part of my forehead if it gets really bad.

That only lasted a day. Weird, huh?

In answer to your question about my ankles...no I have not had xrays

done on them...yet. I'm guessing that if I don't get a

rheumatologist by the time I go in to my doctor again next month,

she will order them. My cholesterol is also quite high, but she

said she doesn't even want to think about treating that until we

find out what is going on with this. Considering I have heart

disease in my family and have at least two separate arrhythmias, and

have had surgery to correct one of them which was only partially

successful, holding off controlling my cholesterol tells me she is

pretty worried about what is going on. She did say that she is

concerned, and wants an answer as quickly as possible, but doesn't

know enough about autoimmune disease to pursue it herself.

I'm just a little frustrated and confused, that's all. I don't have

much patience, anyway, and when I'm sore and cranky I have even

less. I'd like to figure out what is going on so I can start

treating it, and at least minimize the damage. I'd also like to not

be tired anymore, and I'd like the pain to go away, too. Not asking

for much, am I?

[Guest guest]

Thanks, a.

I actually have gone and read a few of the sites you mentioned in

this post already, and I read the ones you suggested earlier, but

putting them all together makes even more sense. Thank you. I've

gotten " stupid " in the last year or so, and it is frustrating. I

actually know someone with ANA-negative lupus, which she contracted

after a bout with lyme disease. I'm not sure if this rheumatologist

believes in it, though. The lab highly suggests retesting in 2-4

weeks to see if the anti-dsDNA has gone up or my ANA becomes

positive. I doubt he'll do it.

I also understand the CRP will go down faster than ESR, but if my

ESR rose 10 points in three weeks, does it make sense that the CRP

is still " normal " ? I also thought that RF rises when the disease is

more active...mine had more than doubled in that three weeks. I'm

still not sure if the N in the results is correct or not, since both

references for normal on the test were much lower than what mine

was. It just doesn't make sense to me, and, of course, I'm probably

not going to get an answer from this rheumy. I do know that a

couple of days before my appointment, I suddenly went through some

really severe muscle and joint pain. It only lasted a couple of

days, and was starting to get much better the day I went in, though

I was still pretty darn sore. This was the first time my hands and

feet were involved more than being stiff, and the area around my

joints in my knuckles swelled noticeably, and my knuckles were red.

I also had a reddish rash on my cheeks and nose, much like the one I

get when I'm outside too long, but much larger, covering my entire

cheek and nose, rather than just the upper portion of my cheek and

maybe the bridge and part of my forehead if it gets really bad.

That only lasted a day. Weird, huh?

In answer to your question about my ankles...no I have not had xrays

done on them...yet. I'm guessing that if I don't get a

rheumatologist by the time I go in to my doctor again next month,

she will order them. My cholesterol is also quite high, but she

said she doesn't even want to think about treating that until we

find out what is going on with this. Considering I have heart

disease in my family and have at least two separate arrhythmias, and

have had surgery to correct one of them which was only partially

successful, holding off controlling my cholesterol tells me she is

pretty worried about what is going on. She did say that she is

concerned, and wants an answer as quickly as possible, but doesn't

know enough about autoimmune disease to pursue it herself.

I'm just a little frustrated and confused, that's all. I don't have

much patience, anyway, and when I'm sore and cranky I have even

less. I'd like to figure out what is going on so I can start

treating it, and at least minimize the damage. I'd also like to not

be tired anymore, and I'd like the pain to go away, too. Not asking

for much, am I?

[Guest guest]

You have a non-zero RF on your test and this guy says you don't have

RA??? I have RA and I'm one of the 20% or so that never registers RF

on the test.

Nina

>

> Hey guys,

>

> Well, I saw the rheumatologist for the first time about a week ago,

> and suffice to say I didn't like him. ... He looked at my hands,

manipulated my knees

> and wrists (which hurt a little, but not bad), and told me I didn't

> have rheumatoid arthritis.

[Guest guest]

You have a non-zero RF on your test and this guy says you don't have

RA??? I have RA and I'm one of the 20% or so that never registers RF

on the test.

Nina

>

> Hey guys,

>

> Well, I saw the rheumatologist for the first time about a week ago,

> and suffice to say I didn't like him. ... He looked at my hands,

manipulated my knees

> and wrists (which hurt a little, but not bad), and told me I didn't

> have rheumatoid arthritis.