Influences on the Rheumatoid factor test?

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Aldo
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Date Joined Jan 2006
Total Posts : 289
   Posted 6/28/2006 3:59 AM (GMT -7)   
Hi all. This is my first post here. I usually post on the heart disease section. I will trade info with you, lol. No, I have RA but I haven't had a flare in about 6 years. I have had vague body aches and joint pain since then, but no extreme swelling and unusable hands until about 7 weeks ago.
 
I got the results from my RH factor test yesterday. Normal for the negative range is from 0-13.9 (in my part of the country). My result was 10.3. My question is; I started corticosteroids 4 days before the blood test and I think that I have read before that this can lower your test results and was wondering if any of you know about this.
 
My doctor has already diagnosed me, due to the nodules on my dominant forearm, and the swelling in my middle knuckle joint on each hand. All the joints in my body seem to be affected. My family doc told me that ~30% of people with RA, do not show positive on this test.
 
I am taking the Dexpac, I believe. You start off heavy on the steroids and then taper off.
 
Would appreciate any info on this very much :) Thanks in advance.
 
Rj

Post Edited (Aldo) : 6/28/2006 5:04:38 AM (GMT-6)


RandomDave
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Date Joined May 2006
Total Posts : 164
   Posted 6/28/2006 5:30 AM (GMT -7)   
Hey Rj,

Your question about corticosteroids lowering your Rheumatoid factor is kind of difficult to answer. If you previously had a high RH, the doctor may monitor the RH to monitor your response to the treatment. If it lowers, it can be an indication that the treatment is working. In your case, it sounds like there were no blood tests before you started the corticosteroids, so really it could be that it was previously high, and the treatment has lowered it, or it could be that it was never high to begin with. I'm not positive, but I suspect that 4 days of treatment wouldn't lower it to normal level, unless it wasn't all that high to begin with. In my case, my rheumatoid factor usually checks in around 90 or so, and my rheumatologist considers it great news if it gets down to 70-75 over a three month period. Personally, I don't notice any difference in how I feel no matter what the number is. She says she doesn't usually watch it all that carefully, but she uses it to monitor me because my ESR is always normal, and she can't tell anything from it.

From what I've read, approximately 20 - 30% of people with RA will never show an elevated Rheumatoid factor (seronegative RA). It may be that you are one of these people. I guess all you can do is keep track of it, but don't use it as a disease indicator, unless it gives you a reason to. Sorry I couldn't be of more help. Some of the "steroid people" should come around with more specific info for you. Welcome to the arthritis neck of the woods!
-SLE, RA & PA....it's all about the acronyms!

-Current meds: Plaquenil, Sulfasalazine, and a little NSAID du jour for flavouring. Mmmmm NSAIDs.


Aldo
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Date Joined Jan 2006
Total Posts : 289
   Posted 6/28/2006 7:01 AM (GMT -7)   
Hey thanks a bunch Dave. You have helped me a lot. If we are speaking the same test reference numbers, you have me beat, hands down :)

My grandfather was crippled with RA starting in his early fifties. 6 years ago I was diagnosed as having RA, by a DO who has RA himself. The RH factor test was negative then also. He went by the symmetry of the affected joints and nodules on my forearms. I also could barely walk. I am now 53.

I have nodules above my kidneys, in my back. Another doc told me that these were harmless fatty tumors. Have you any info on whether RA folks get these in this area?

I have been too busy fighting heart disease. My blood work came back with several abnormalities. Most I think are from all the medicines I have to take.....I am afraid that RA is affecting my heart now, so I must venture over into the "RA arena", lol.

Thanks again and be well,

Rj

RandomDave
Regular Member


Date Joined May 2006
Total Posts : 164
   Posted 6/28/2006 7:58 AM (GMT -7)   
Hey again Aldo,

As for nodules, I've never heard of people gtting them in the kidney area. Primarily, I think most people get them around the elbows. Personally, I've had some on the hard cartilage on my ear, and my rheumy seemed kind of surprised and kept feeling them over the course of my appointment. I've also had some in my hand that were causing trigger finger. So, I do know that they can be in other places besides the elbows. Maybe someone with more info on that will come by. Do you see a rheumatologist? If so, I would mention it to them to make sure they are related to arthritis. For me, nodules feel sort of like little pellets under my skin. I googled some of your info, and discovered something called a lipoma. Here's a link if you want to check it out...

http://www.mayoclinic.com/health/lipoma/DS00634/DSECTION=1
-SLE, RA & PA....it's all about the acronyms!

-Current meds: Plaquenil, Sulfasalazine, and a little NSAID du jour for flavouring. Mmmmm NSAIDs.


elcamino
Veteran Member


Date Joined Sep 2005
Total Posts : 1744
   Posted 6/28/2006 8:36 AM (GMT -7)   

I could be wrong, but I thought the RF test was not a good indicator of disease activity.  I know that my insurance will not pay for my rheumy to monitor my RF--he can only measure it once a year or so (no more than that).  I think if it shoots up from a baseline reading (as you suggested Dave), that can be an indication that the disease has gotten a bit more aggressive.  However, it's not a good indicator of treatment success, since a lot of people have a positive RF and do not have RA (it is associated with a variety of different diseases), and even more people have a negative RF (such as you Aldo) but do, in fact, have RA.  I believe the actual titer is not as important as whether it meets the cutoff or not (whether it's positive or negative). 

My RF is always stubbornly positive, but very low positive (usually in the 20's).  Rheumy believes it's meaningful, but exactly what it means we don't know?

Elcamino


Current dx: Rheumatoid Arthritis
Suspected dx: Early Lupus/MCTD
Current Meds: Enbrel, Plaquenil, Aciphex, Ultracet, Zyrtec, Allavert-D, Zantac, Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan


RandomDave
Regular Member


Date Joined May 2006
Total Posts : 164
   Posted 6/28/2006 8:59 AM (GMT -7)   
Yeah I agree with you elcamino. Really there is no good single indicator of disease activity that works for everyone. My problem is that the only numbers of mine that are completely out of whack are my rheumatoid factor (way high), my ANA (way way high), and my white blood cell count (pretty low). Usually, she would be more inclined to use my sed rate, but in over 10 years of regular blood work, it has never been abnormal.

That's crazy that they won't pay for more than once per year. I get mine done at least monthly. I do monthly bloodwork because I'm on suflasalazine, and it's always part of that. And then now and then she'll send me for some other blood test not part of the regular monthly tests and it's on there too. To me, each test is just part of a picture and means very little on its own.
-SLE, RA & PA....it's all about the acronyms!

-Current meds: Plaquenil, Sulfasalazine, and a little NSAID du jour for flavouring. Mmmmm NSAIDs.


Aldo
Regular Member


Date Joined Jan 2006
Total Posts : 289
   Posted 6/29/2006 10:01 AM (GMT -7)   
You guys make too much sense :) I really am so appreciative of this discussion and what I am learning. Dave, I have my first appointment with a rheumotoligist Monday and a pain clinic on Wednesday. about 7 years ago, my family doc was a DO and had RA from childhood. He was an expert on the subjest but was not a rheumy.

I have had a few blood abnormalities discovered after going to a quack, lol, about 7 months ago. At least he ordered all the blood work that can be done! My ANA, MCV and some things in addition to the fact that I have a chronic, active infection with the Epstein Barr Virus. I gave the results to my cardio and he sent me to an infectious disease doctor. He tested and tested more with the different subsets of ANA and finally said I might be ok, lol. He diagnosed me with chronic fatigue and arthralgia. I didn't mention the previous bout with RA.

I am most interested in the links you provided. Haven't been there yet, but will.

Do any of you take hydrocodone plus? This medicine gives me a headache! My WBC count was high so I am on a heavy duty antibiotic, Biaxin, I believe. I am still on the corticosteroid treatment and that is affecting my mind...I am not sleeping much either. Too many drugs. It has increased my BP also. I am just throwing things out here so that if anyone has ideas, well, shout them out.

I like the way you guys have organized your medicinal signatures.

Thanks again to both of you for your help.

Best of health and happiness to you all,

Rj

erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 6/29/2006 10:23 AM (GMT -7)   

Dear RJ,

Great to have you!  Welcome to the club. LOL. 

Just to get back to the RA nodules.  RA as you know is systemic like Lupus, so nodules can appear on the hear & lungs (yours truly).  I've got problems with the RA affecting the heart valves.  So in all, it'll sure make heart conditions a wee bit more complex to treat & deal with.

Ugh!  I haven't slept right in months!  The steroids keep me up & cause shortness of breath and a rapid heart beat (just spent a week on prednisone and solumedrol shots). Terrible isn't it?

The pain med you take does have a reputation for causing headaches.  I have dilaudid, Avinza (morphines) and they've been good so far, no headaches.  The prednisone gives me headaches (and I'm not prone to headaches either).

And with the RA factor, it's a titer (like the chicken pox titers they test for when kids go to school)...so theoretically once it shows up most likely it will never go away.  A useful tool for getting an idea about inflammatory joint diseases...but the pisser it is...it can show up in ANY of the rheumatic diseases.

Takes an artist to be a rheumatologist eh?

Take care RJ,

erin     


Active, Severe Rheumatory Arthritis. Crohns. AS. Chiari Malformation & Right Brain venous anomoly. Partial complex seizures. Emphysema. Rheumatic Lung & Heart. MVP and Tricuspid prolapse. Had Lymes disease for 10 years.
Meds: Humira 40mg Q 4 days; Pred 20mg prn; Pentasa 4G daily; Imuran 50mg; Dilaudid 4mg; Diazepam 5mg; Avinza 30mg; Reglan; Meclizine; LidoDerm; MiraLax & too many others.


Aldo
Regular Member


Date Joined Jan 2006
Total Posts : 289
   Posted 6/29/2006 3:13 PM (GMT -7)   
Erin, thanks so much ! You guys are holding my hand here :) I'll tell you now that it has been a great help. I am pushing it to stay out of the hospital, or worse, lol. Never felt quite so bad, but at least I am not alone. Now that's rude, ha.... I am so sorry to hear about those nodules on your heart and lungs. I have 4 stents and just had a rotational arthectomy in lieu of bypass surgery 4 months ago. They crammed a lot of tools into my heart. Maybe shook lose some RA dust....

I have recently read about RA and how it can affect the heart. I did,'t read too long though...I had a 8th heart cath done 2 weeks ago, due to chest pain. I thought for sure that they would have found another blockage. It made me feel better to find that out, but the chest pain was not explained. I guess that is down the road (I hope so :) ) Now my head is beating like a drum and my ears are ringing like a siren....

Thanks again for your information and many blessings to all,

Rj

RandomDave
Regular Member


Date Joined May 2006
Total Posts : 164
   Posted 6/29/2006 6:21 PM (GMT -7)   
Hey RJ,

Let us know how your rheumy appointment goes. If you have any interesting websites about heart disease, I'd be interested in reading them. My dad has CHF, and I'm kinda curious about learning more about it. Good Luck!
-SLE, RA & PA....it's all about the acronyms!

-Current meds: Plaquenil, Sulfasalazine, and a little NSAID du jour for flavouring. Mmmmm NSAIDs.


Aldo
Regular Member


Date Joined Jan 2006
Total Posts : 289
   Posted 6/30/2006 5:10 AM (GMT -7)   

I sure will Dave. I received some pre-what's been wrong with me-material to fill out before Monday. Whew, this will have to be weekend homework, lol.

So sorry to hear of your Dad's condition. Is it chronic or congestive heart failure?

This is probably the most used site for practical information about all types of heart failure, treatments, diet and medication. Jon is just a guy that developed CHF early on and has learned to cope with the illness and which medicines work better with the least side affects.You know, probably like you guys have done here, and well indeed you have.

I have been retired since my mi (heart attack, don't like those words) and stroke. I have searched the net for that same time and studied heart disease. I still know nothing :)

It is very important for him to watch his water retention (edema), regardless of the type of heart failure. This usually means no salt or low salt and a powerful diueretic like Lasix. He should also be on a beta blocker that is highly recommended for heart failure and is called Coreg. It is the latest and greatest BB. It has some additional properties, as compared to other BBs, that helps the lining of the arteries. He should also take an ACE inhibitor, such as Altace. ACE =Angiotension Converting Enzyme. It lowers BP not as well, but in addition to a BB. It is a vasodilator which reduces the workload on the heart. BBs do that much better also. These are standard medicinal therapies established by the NIH and mostly adhered to by the docs. Statistics show improved longevity after diagnoses.

Lasix depletes potassium and an ACEi increases potassium. Too much or too little is very dangerous. His blood electrolytes need to be checked fairly regularly. He also needs an echocardiogram at least once per 3 months. This is a totally non-invasive test that measures all the dimentions of the heart chambers and valve condition and leakage past the valves (backward flow). This test can also show abnormalities in the aorta, heart wall motion and most importantant of all I guess, calculate his ejection fraction (EF). The EF is the overall efficiency of his heart as a pump. It is simply the amount of blood ejected from his left ventricle, with each beat. This chamber never totally empties after a beat, so a perfect EF for an athelete is around 65-70. People are said to have heart failure at around 40%. One requirement for SSDI is an EF of <30%.

http://www.chfpatients.com/index.html

Here is a site you have to join (free) and some there are a tad kooky, like meself....and others who are good with advice. I don't go there anymore. The owner of this website is also the moderator.

http://www.heartboard.com/main/

Then you have the Mayo Clinic and the Cleveland Clinic on the net to search all the terms/conditions. Give me a holler if you need any help.

Rj


RandomDave
Regular Member


Date Joined May 2006
Total Posts : 164
   Posted 6/30/2006 7:01 AM (GMT -7)   
Hey RJ,

Thanks for the reply and the links. My dad has Congestive Heart Failure. I'm not sure what the difference between chronic and congestive is, honestly. I guess it started around 1997 when he had his first "MI". He just had a defibrillator put in about a month ago (makes it sound like he was installing air conditioning or something huh?)when he had a ventricular fibrillation at the dentist's office. He's been hospitalized several times over the last couple of years for edema, and is on all the medications you mentioned. Last time they measured his EF (in the hospital when he got his defibrillator) it was 16%. I think a year or so ago it was 28%. I've been lurking around the heart forum here a bit, haven't posted because it's one of those things where I'm not sure what I want to know really, just kind of curious about reading some other people's experiences and see if they get as P.O'd when their father goes over the edge and drinks twice as much as he's allowed. sortaLOL!. Anywho, thanks for the reading material, and sorry to get things off topic.

And now back to your regularly scheduled programming...
-SLE, RA & PA....it's all about the acronyms!

-Current meds: Plaquenil, Sulfasalazine, and a little NSAID du jour for flavouring. Mmmmm NSAIDs.


redrose77
Veteran Member


Date Joined Sep 2005
Total Posts : 2573
   Posted 6/30/2006 7:36 PM (GMT -7)   
RandomDave, had a question. My SED and CRP are always normal even when my joints are hugely swollen, red, and hot my rheumy purposely drew blood during a time when I came in with all my joints in such condition. My ANA is neg, my RF is neg, heck 9 out of 10 times ALL my bloodwork is normal. Yet I have had severe pluersy, pericarditis, etc.. I am now losing cartiledge in my joints- all joints and am wondering if this lack of elivation in SED rate is common.

erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 6/30/2006 7:40 PM (GMT -7)   
To me, it is all physical findings. They're objective so that's good. It is possib;e to have normal labs and have ALL the joint findings. Diagnoses is made using everything...what is coming back normal now might take a long long time to pop up in blood work, some individuals are just like that.
Take care
Active, Severe Rheumatory Arthritis. Crohns. AS. Chiari Malformation & Right Brain venous anomoly. Partial complex seizures. Emphysema. Rheumatic Lung & Heart. MVP and Tricuspid prolapse. Had Lymes disease for 10 years.
Meds: Humira 40mg Q 4 days; Pred 20mg prn; Pentasa 4G daily; Imuran 50mg; Dilaudid 4mg; Diazepam 5mg; Avinza 30mg; Reglan; Meclizine; LidoDerm; MiraLax & too many others.


RandomDave
Regular Member


Date Joined May 2006
Total Posts : 164
   Posted 6/30/2006 10:56 PM (GMT -7)   
What Erin said in a long and boring manner.

Mostly my view is this; focus on what is abnormal even if the doctor says it's probably unrelated. Some (most?) doctors take the view that if something is normal it isn't a problem, and if something unrelated is abnormal it has nothing to do with the issue at hand. To this I say bullpuckey! My theory is that autoimmune disorders are some of the least understood in all of medicine, and 20 years ago (when my doctor was in med school) they were even less understood. Current knowledge says that x is unrelated to symptom y, however current knowledge changes all the time. As an example, after installing teflon joints and having people cook stuff in teflon pans, they sudddenly discover that teflon increases the risk for cancer. Take it back to basics, you have a symptom, and you have an abnormal "whatever". So what if doxtors say it's unrelated. Maybe it is, but it's abnormal, and quite possibly next week they'll decide that maybe it is related after all. And if it was completely unrelated why did they test it in the first place? The thing with autoimmune problems is that there are an awful lot of different ways your body can go about attacking itself. Not only that, I don't believe the nirmal range is the normal range for everyone. If you're borderline in either direction, I would be more inclined to consider it to be not good for the individual for the simple fact they are having symptoms, hence you're normal should be more toward the midrange.

Using myself as an example; My white blood cell count usually comes in right at 4.2 which is the lowest it can be while still being "normal". The highest I've ever seen it is 4.4, while it often dips down to as low as 3.5. I don't keep a journal of how I feel everyday, but I do keep a little notepad file on my pc where I enter how I feel on the day I get my bloodwork done. When I feel bad and I find out that my white blood cell count is low or I feel good and it comes in at 4.4, I associate it with having something to do with my illness regardless of whether the doctor says "oh you probably just had a virus when the low result came in." I may not be a scientist, but to me there is a correlation whether the doctor agrees or not. So, I've discovered a particular thing I can research on my own to help me feel better, I can ask my family doctor what I can do to raise it. Even if it does nothing for me physically, it helps me mentally by gaining control through knowledge. Just because 4.2 is technically normal, maybe I should find how how I can get it to five. And what is normal? Is it normal for being the high mark? or is it normal as a consistent finding? people aren't all exactly the same, and I don't believe their normal ranges are all the same either. To me bloodwork should be used as clues to solve the crime, and a low or high "normal" should be treated as just as much a clue as an over the top completely obvious finding. To me, doctors dismissing these types of findings has the effect of dismissing possible treatments which means you just may never have the chance to find that bridge to feeling better that I'm positive is always out there.

Sorry to be so longwinded, it's a concept I have a hard time explaining properly.
-SLE, RA & PA....it's all about the acronyms!

-Current meds: Plaquenil, Sulfasalazine, and a little NSAID du jour for flavouring. Mmmmm NSAIDs.


erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 7/1/2006 11:53 AM (GMT -7)   
Viola! Very nice thesis! Written beautifully & I absolutely agree.
Are you in the medical field by chance? And I don't mean by participation as a patient. Have you a biology or medical background?
That was a really nice way of explaining Autoimmune Disasters. :)
Active, Severe Rheumatory Arthritis. Crohns. AS. Chiari Malformation & Right Brain venous anomoly. Partial complex seizures. Emphysema. Rheumatic Lung & Heart. MVP and Tricuspid prolapse. Had Lymes disease for 10 years.
Meds: Humira 40mg Q 4 days; Pred 20mg prn; Pentasa 4G daily; Imuran 50mg; Dilaudid 4mg; Diazepam 5mg; Avinza 30mg; Reglan; Meclizine; LidoDerm; MiraLax & too many others.


redrose77
Veteran Member


Date Joined Sep 2005
Total Posts : 2573
   Posted 7/2/2006 3:18 PM (GMT -7)   
Disasters, yes that is exactly what these rotten diseases are. My life was hit by something so out of control it left a disaster area in its wake and recovery or return to "normal" seem to be a long hard process that likely will never be completed.

Aldo
Regular Member


Date Joined Jan 2006
Total Posts : 289
   Posted 7/4/2006 12:12 PM (GMT -7)   
To add insult to injury :), I wonder about the quality of the labwork on average around our country/world? The lab I was in yesterday had some awe inspiring protocol. Things looked hectic. I saw a documentary the other night where a woman had breast cancer surgery because of her lab results being confused with one who really had breast cancer. They never mentioned the lady that actually had cancer??

Rj

erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 7/9/2006 6:52 AM (GMT -7)   
hey Aldo,
you're absolutely correctamundo! scool labs do vary.  say for instance in NJ we have LabCorp and LabXYZ...even though the same blood test is taken, if you send it to the 1st lab you might get an abnormal result but the 2nd lab say would come back normal.  there are variances in the reference ranges.  so many times if you have negative bloodwork coming out & demonstrating all positive symptoms...a doc will sometimes switch labs just to see if it makes a difference.
confused  oh so comforting isn't it? LOL
take care,
erin
:-)  
Active, Severe Rheumatory Arthritis. Crohns. AS. Chiari Malformation & Right Brain venous anomoly. Partial complex seizures. Emphysema. Rheumatic Lung & Heart. MVP and Tricuspid prolapse. Had Lymes disease for 10 years.
Meds: Humira 40mg Q 4 days; Pred 20mg prn; Pentasa 4G daily; Imuran 50mg; Dilaudid 4mg; Diazepam 5mg; Avinza 30mg; Reglan; Meclizine; LidoDerm; MiraLax & too many others.

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