New to the site - help please

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nina777
New Member


Date Joined Oct 2008
Total Posts : 3
   Posted 10/7/2008 11:31 AM (GMT -7)   
Hi all - I'm new to the site. Got on here to try to find some answers for my best friend. I know no one can "diagnose" on here, but would a few of you who have had experience in looking at auto-immune disorders take a look at her test results and give your opinions as to what we could possibly be dealing with?
 
She is 47 years old. Clinical symptoms don't seem to match any one particular auto-immune disorder (pain and tingling in her feet, hands, legs, arms; weakness; fatigue; heart palpitations and pain around the heart; gastritis; heartburn). She does not have dry eyes or mouth, but does have other symptoms of Sjogrens. She has no butterfly rash or skin rash, but does have sun sensitivity in that the sun makes her "flare" worse.
 
Test results are as follows:
 
ANA titer 1:1280
Nuclear Ab Pattern: SSA/Ro with SSA > 8.0 and SSB 1.7
RA 77.03 IU/ml (range + >8.9, neg. < 6.5)
Extractable Nuclear Ag Ab < 1.0
Smith Ab < 1.0
Smith And RNP Ab, EIA < 1.0
SCL-70 Ab < 1.0
Double Stranded DNA Ab < 4
ESR 49
 
Her CBC is normal except for blood cell indices as follows:
Hgb 11.4
Hct 35
MPV 7.3
MCV 80.5
MCHC 26.3
RDW 15.9 (this is increased and shows a wide cell size distribution---no manual differential was done however)
 
Other blood levels that are elevated are:
Total Protein 8.9 (6.0-8.3 nor. range)
Potassium 3.5 (3.6-5.0 nor. range)
 
Her urine shows positive for bilirubin as well 1+
 
We may be looking at more than one issue as she had serious gall bladder disease about a year and a half ago and had her gall bladder removed. Because it took the doctors so long to diagnose her though, her pancrease was affected. Her liver functions tests all came back normal, although they did not repeat her amylase or lipase this time. (which still could be elevated)
 
We would greatly appreciate anyones insight or input. I can't find any sites relating to the Nuclear Ab patterns that would help me differentiate between Sjogrens and Lupus---at least not any that make sense. confused
Thanks all!
nina777
 
 
 
 
 

AlwaysRosie
Veteran Member


Date Joined Jan 2005
Total Posts : 8616
   Posted 10/7/2008 12:02 PM (GMT -7)   
Hi Nina,

I think that you need to show the "normal ranges" for each of your items above for most people to help. They can vary from lab to lab and machine to machine.

Even at that, I sure can't help you. But I believe the nuclear antibody pattern is associated with scleroderma which is another connective tissue disease (also autoimmune).

Is your friend seeing a rheumatologist? If not, it is probably a good idea. Sometimes a primary care doc will hang on to a patient too long before referring them.

If she has rashes or mouth sores, make sure to have her take a picture so she will be able to show her doctor/rheumatologist what it looks like. This can be helpful to them.

I hope you'll let us know what you find out.

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

Co-Moderator - Lupus Forum

UCTD, Inflammatory Arthritis, Diverticulosis, (recent dx - Sjogrens, Crohn’s 4/08)

Clickable Links:  Lupus Resources    Lupous.Org   Lupus Criteria (4 of 11)   Lupus Chapter Locator


nina777
New Member


Date Joined Oct 2008
Total Posts : 3
   Posted 10/7/2008 5:27 PM (GMT -7)   

Thanks Rosie----I listed the normal range for the RA, and of course anything over 1:40 for the ANA titer is elevated. Her ANA was "homogenous" if that helps narrow anything down.

Both of the Nuclear Ab patterns - anti SSA and anti SSB are elevated (< 1.0 is the norm for both). The ESR is elevated according to the method that was performed.

All of the other Ab tests I listed (Smith through Double Stranded DNA) are within the normal limits---I just listed them in case someone knew how to use them to further rule out something else. :)

She has been referred to a rheumatologist, but even here in the Atlanta area, where you'd think there would be plenty of rheumatologists, she had to wait several weeks to get in.
 
I will let you know what the doctor comes up with though. I wish the tests for "auto-immune" diseases were more definitive, but it's all a bit muddy.
 
I've had Hashimoto's for a number of years, and it took doctors quite a while to figure out I had it.
I have two sisters with Celiac disease and one of those has lupus also. I've recently had the DNA tests done for celiac and they were negative. PTL!
 
Thanks again for your help!
Nina

AlwaysRosie
Veteran Member


Date Joined Jan 2005
Total Posts : 8616
   Posted 10/7/2008 5:43 PM (GMT -7)   
Hi Nina,

Info from "Lupus Resources", link at the end of my signature:
Lynnwood said...
More specific info on what your ANA test might mean:

The homogeneous (smooth) pattern is found in a variety of connective tissue diseases as well as in patients taking particular drugs such as certain anti-arrhythmics, anti-convulsants or anti-hypertensives. This pattern is also the pattern that is most commonly seen in healthy individuals who have positive ANA tests.

The speckled pattern is found in SLE and other connective tissue diseases, while the peripheral (or rim) pattern is found almost exclusively in SLE. The nucleolar pattern is found primarily in patients who have scleroderma.


So . . . the homogeneous pattern isn't specific to Lupus, but doesn't rule out lupus either.

I trust your Hashimoto's was easily treated. That can mimic lots of Lupus symptoms too. *sigh*

I hope you'll keep us updated on your friend.

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

Co-Moderator - Lupus Forum

UCTD, Inflammatory Arthritis, Diverticulosis, (recent dx - Sjogrens, Crohn’s 4/08)

Clickable Links:  Lupus Resources    Lupous.Org   Lupus Criteria (4 of 11)   Lupus Chapter Locator


nina777
New Member


Date Joined Oct 2008
Total Posts : 3
   Posted 10/7/2008 6:08 PM (GMT -7)   
Thanks so much Rosie! I'm hoping and praying that it's not Lupus, but perhaps Sjogrens---even though Sjogrens is often secondary to Lupus or RA. cry
 
Yes, the Hashimoto's is currently under control, although my antibodies went up drastically last summer following a bad reaction to a TDP booster (tetanus, diptheria, pertussis) shot I was told I needed before returning back to work in the medical lab/urgent care clinic. I was taking iodine supplements for the past year until I read an article that said iodine can cause an increase in the thyroid antibodies. good grief! So after getting off of that, taking IGg supplements that my doc gave me, and switching from natural thryroid back to Synthroid, the antibodies have finally started to come down. Oddly enough sythetic thyroid can actually bring the antibodies down better than natural thyriod. They are still in the 400s, but that is down from the high 600's last October.
 
I also deal with Meniere's disease. Had a very bad bout with it last September that took almost 8 weeks to get through. (couldn't drive for six weeks due to the severe vertigo)
 
Life is a challenge, but I trust the Great Physician to get me through! :)
 
Blessings!
 
 
 
Nina777

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