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Posted By : hpymomof3 - 9/19/2017 10:41 AM
I also posted this on the Lupus board since I didn't know where to post:

My rheumatologist has been treating me with Humira for seronegative ankylosing spondylitis. Since I've had positive ANA continually for several years and I also have other symptoms so she still suspects I have more going on and at times has considered Lupus. Up until recently my ANA hasn't been that high. Yesterday though it came back 1:1280, although my inflammatory markers and those for Lupus still come back negative. My sed rate is only slightly elevated. My doctor is diagnosing me with inflammatory arthritis and wants me to add Methotrexate. I'm a bit nervous about taking it due to possible side effects, although she is also putting me on folic acid. Would you start on the Methotrexate? Also I know that a positive ANA doesn't necessarily mean anything but can it be that high and also continuously be positive and not indicate anything?

Posted By : Scott007 - 9/21/2017 5:37 AM
Hi hypmomof3,

Well, over 50 views and no one has taken a stab at it. I'll give it a try!

First, do you know what ANA is and what the number means? ANA is an acronym for "anti-nuclear antibody", an antibody which targets "normal" proteins in the nucleus of the cell. The number is derived from a process called "serial dilution". One part of blood is initially mixed with 40 parts of saline and is then serially diluted until the number for ANA is 1. At 1:1280, it took 5 serial dilutions, indicating a very high ANA.

So, your immune system has suddenly gone into hyper drive. Methotrexate is almost always the default treatment, but your concern about side effects is valid. I have offered an explanation for the cause of autoimmune disorders in my thread on "Resistant Starch". I know that some find it hard to believe that the problem lies within the colon, but I just wrote a new post today at the bottom of page 3 of that thread which sheds additional light on this scientific analysis.

Posted By : hpymomof3 - 9/21/2017 8:20 AM
Thank you for getting back to me. I read your posts about the potato starch and I'm going to try that. I'm the meantime I'm not sure what to do about the Methotrexate and the Humira. Should I take it for a few months until I can see results from the potato starch? I've been on the Humira without any problems but I'm sorry concerned about the Methotrexate.

Posted By : Scott007 - 9/21/2017 9:20 AM
Hi hpymomof3,

Yes, what to do in the meantime. You said "My doctor is diagnosing me with inflammatory arthritis and wants me to add Methotrexate." What test was taken by your doctor to diagnose you with inflammatory arthritis?

It is clear that you have an autoimmune disorder, but it is not clear which one or if you have more than one simultaneously. If the Humira (an anti-TNF-α biologic) has not been helping, then it is possible that your autoimmunity is not T-cell-mediated. It might be mediated through B-cells. In that case, giving Rituxan (another biologic) a try would be better than going directly to methotrexate. If Rituxan works, then it would confirm B-cell mediation and that would be an important determination. Methotrexate will not confirm anything.

Posted By : hpymomof3 - 9/21/2017 11:45 AM
My rheumatoid factor is normal and my sed rate is only slightly elevated. None of the more specific tests are positive. She also thinks I have ankylosing spondylitis but again the blood test was negative for that. She is basing that diagnosis on my MRI which shows some changes in my SI joint as well as pain and stiffness in the SI joints. I also just had back surgery for Tarlov cysts so that complicates things. As far as the inflammatory arthritis I think she is diagnosing that based on my symptoms and my high ANA. I also respond well to steroids so she said that was another indication. I didn't think the Humira was working but when I was off it for a few months following surgery I was worse. I also tried Enbrel but that didn't help.

Posted By : straydog - 9/21/2017 11:55 AM
This is not one of the busier forums here at Healing Well. Secondly only members can post. Healing Well has a huge reader base only. Public forums are not for everyone, some people prefer to read & not post.
Susie
Moderator in Chronic Pain & Psoriasis Forums

Posted By : Scott007 - 9/21/2017 12:21 PM
Hi hpymomof3,

With many of the specific tests coming up negative, accurate diagnosis is more complicated. The worsening condition after going off Humira for a while supports a T-cell component in the dysfunction. A contribution from B-cells is unclear.

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