Does anyone know much about Rheumatology blood tests?

[Tap]

I am waiting to call my daughters doctor until all her tests are in, so I am curious if this is considered complete or not.  Her PCP is not part of the medical group where the test results are posted, so he can't put notes on her file there.  I need to wait to talk to him on the phone.

 

 

DD17 has some unexplained back pain, so they have ordered a bunch of tests on her. I completely understand that ANA testing is not reliable for diagnosing health issues. But I am really curious about the results.  I don't want to bug her PCP before the tests all come in, because the rheum Dr really kinda dumped the work load onto her PCP.  

 

3/18/2016 215pm. 

ANA ELISA Scrn-

positive

Results Complete

Comments:Positive for ANAs by ELISA screen, reflex ANA IFA titer and pattern pending. 

 

(nothing else has been posted to the online test results page since then)

 

3/18/2016 2:30pm

ANA IFA-

negative 

Results Complete

 

 

So, does this mean that the test results that were pending came back negative? or are they actually completely different tests?  or am I misunderstanding the 'pending' to mean that more results are still coming?

 

Just in case anyone is interested her other results are all looking negative  :hurray:  There are a lot more results than these, but I think these are the specifics that the Rheum Dr wanted.

 

HLA B27 Typing

negative

 

RA Factor

normal range 

<10

 

Sed Rate

normal range

3

 

Lactic Acid

normal range

140

 

C Reactive Protein

normal range

<1.0

 

Edited March 23, 2016 by Tap

[Arcadia]

I had blood screening and X-ray for juvenile RA at 17. I don't have the word "pattern" on my preliminary report but did have pending for the pending diabetics and hepatitis test results. I think it was three days before I got my thick complete stack of results back in 1990.

[Joules]

There are two types of ANA tests, ELISA and IFA.  It looks like the first came back positive and the second negative.  The IFA is the test with the patterns, so if it is positive you will get specific pattern seen on fluorescence: speckled, centromere, etc.  These patterns tend to show up in specific autoimmune diseases, so they help with differential diagnosis.  You won't get a pattern since the IFA was negative.

 

It sounds like good news to me (unless you were really hoping for a definitive diagnosis).  There are false positives on ANAs so with only one test positive, there isn't very strong indication of autoimmune disease without any other positive tests.  I think things like mono can give positive ANA.

[Tap]

There are two types of ANA tests, ELISA and IFA.  It looks like the first came back positive and the second negative.  The IFA is the test with the patterns, so if it is positive you will get specific pattern seen on fluorescence: speckled, centromere, etc.  These patterns tend to show up in specific autoimmune diseases, so they help with differential diagnosis.  You won't get a pattern since the IFA was negative.

 

It sounds like good news to me (unless you were really hoping for a definitive diagnosis).  There are false positives on ANAs so with only one test positive, there isn't very strong indication of autoimmune disease without any other positive tests.  I think things like mono can give positive ANA.

Yay!

 

I was hoping someone would say that.  I will contact the dr today and hopefully we can start moving forward on figuring out what is wrong with her.  It looked like the test results said that the ANA IFA and spread were pending, but then the results for ANA IFA were posted 15 minutes later, so why bother putting the 'pending' in there.  LOL  

 

Thanks!

[Cindy in FL.]

My oldest son has had a positive Elisa ANA test for over 15 years, with other extensive testing for autoimmune issues being negative. He did also have a low platelet count which was diagnosed as ITP and he had his spleen removed a year and a half ago. That was not related to the positive ANA according to the dr.

 

I hope that you can get to the bottom of whatever you dd has and that it will be easily taken care of!

[mommytobees]

I care less about the ANA (once positive, always positive....and you can get a false positive---headache).

 

I DO care about the SED rate, the c-reative protein, and the RA factor.

 

Why?

 

ANA is only going to tell you if there are antinuclear antibodies in the blood stream. It isn't going to tell you why? So, for me...I have a positive ANA first, because I have Grave's Disease, dx'ed in 2002. It did nothing to tell us that I have Sjogren's and Lupus too. Furthermore, ANA isn't always the end-all test.

 

SED rate is another test that isn't going to tell you much, but it will tell you if your body is inflamed. Last month, my SED rate was all of 4. WOOT!! I was happy with it. 12 months ago, my SED rate was 15, still considered "normal range", but for me was really bad. You could see the inflammation in my face, neck, feet, and hands.

 

C-Reactive protein is another test that checks the inflammation levels.

 

RA factor is another antibody factor test. The rheumatoid antibody binds with other antibodies in the blood stream. If positive, you have Rheumatoid Arthritis. 

 

Looking at the numbers your daughter's test shows:

ANA-E: positive

ANA-I: negative

RA: <10

SED: 3

CRP: <1.0

 

I would be happy with those numbers. I would take the ANA-E positive as being a false positive (plus that version is unreliable). 

 

IF the SED rate or CRP go up, reconsider the other tests.

 

Now...may I ask why your PCP sent her to a rheumy in the first place? I'm not surprised the rheumy doc dumped the results onto the PCP, as she probably didn't need to be seen by rheumy. I'm unimpressed with that doctor's "bed-side manner" though.

 

Kris, who has Lupus, Sjogren's, and Grave's and possibly MS

My mom has RA and my 17yo son has MS

 

[Tap]

I care less about the ANA (once positive, always positive....and you can get a false positive---headache).

 

I DO care about the SED rate, the c-reative protein, and the RA factor.

 

Why?

 

ANA is only going to tell you if there are antinuclear antibodies in the blood stream. It isn't going to tell you why? So, for me...I have a positive ANA first, because I have Grave's Disease, dx'ed in 2002. It did nothing to tell us that I have Sjogren's and Lupus too. Furthermore, ANA isn't always the end-all test.

 

SED rate is another test that isn't going to tell you much, but it will tell you if your body is inflamed. Last month, my SED rate was all of 4. WOOT!! I was happy with it. 12 months ago, my SED rate was 15, still considered "normal range", but for me was really bad. You could see the inflammation in my face, neck, feet, and hands.

 

C-Reactive protein is another test that checks the inflammation levels.

 

RA factor is another antibody factor test. The rheumatoid antibody binds with other antibodies in the blood stream. If positive, you have Rheumatoid Arthritis. 

 

Looking at the numbers your daughter's test shows:

ANA-E: positive

ANA-I: negative

RA: <10

SED: 3

CRP: <1.0

 

I would be happy with those numbers. I would take the ANA-E positive as being a false positive (plus that version is unreliable). 

 

IF the SED rate or CRP go up, reconsider the other tests.

 

Now...may I ask why your PCP sent her to a rheumy in the first place? I'm not surprised the rheumy doc dumped the results onto the PCP, as she probably didn't need to be seen by rheumy. I'm unimpressed with that doctor's "bed-side manner" though.

 

Kris, who has Lupus, Sjogren's, and Grave's and possibly MS

My mom has RA and my 17yo son has MS

Thanks!  That does help!

 

DD17 has had back pain since Oct15.  The reason for the rheum dr visit.....sometimes her pain is debilitating, sometimes just annoying, but always there.

 

She is a cheerleader, so when the pain first started, it was presumably a normal injury.  Possible sprain/strain, over use etc.

 

PT for 4 months didn't help (excellent PT who worked on her core and back)

Mri showed a slight bulge in L4-L5 but no nerve impingement, so they don't think this is the problem.

XRay- clear

Bone Scan- clear.

 

Physiatrist suspected a Pars fracture/ compression fracture, had her completely rest her back for 6+ weeks (no cheer and no activity that wasn't absolutely necessary) over Christmas break.  She feels fine laying down, but then hurt the more she moves around.    MRI and bone scan cleared both issues from possible sources of pain.

 

She has 2 PCP (right between seeing a pediatrician and adult internal med doctor).  Neither have any idea why she is hurting. They are both the type of doctor to refer out to specialists. 

 

She is hyper-flexible, so there is a slight possibility that she has a connective tissue disorder.  

 

Her physiatrist/orthapedist/sports medicine doctor was moving at the end of February so he wouldn't be seeing her any more after the bone scan.  He is the one who referred her to the Rheumatologist.   I have sjogrens, her dad has psoriasis, her aunt has RA, so there is an increased risk for her to have a rheum issue also.

 

The Rheumatologist feels that the referral was appropriate, but also says he doesn't see anything glaringly obvious. He requested the blood work, and requested another MRI with contrast to rule out a few other rheum issues.  We haven't done that yet.  The Rheum was the one who handled it oddly.  Instead of placing the blood work himself, and ordering the MRI, he gave me a list for the PCP to order.   He said he wanted to see her in 4 months no matter what, and if there was something that came up in the blood work or MRI, he would call and schedule a more immediate appt.  The rheum also wants her seen by an orthopedist, but instead of doing the referral himself , again he is putting it back on the PCP to do the work.  The PCP has only seen her one time for this issue, because everything has been handled by the specialists. 

 

So her PCP, was kinda forced to get all the authorizations and to compile the results in stead of the rheum dr.  The rheum dr even said that if the PCP didn't want to keep looking for answers for her pain, that he would oversee the care. So why? would he make the PCP write all the orders?  The PCP is in a very small medical practice of half a dozen doctors....the rheum is part of a huge, mulitstate practice, so it isn't like he doesn't have the staff to do the work for him. 

Edited March 24, 2016 by Tap

[mommytobees]

First, I wouldn't go back to that rheumy. Those tactics scream "I don't want to pay my staff to do these tasks. So, hand it off to the PCP and let them pay for that service." 

 

Second, reading all of that....I'd take a closer look at Lupus or another auto-immune condition too. Crud!! That just bites. I'd keep a close eye on her over the next several years. 

 

Kris

 

 

Thanks!  That does help!

 

DD17 has had back pain since Oct15.  The reason for the rheum dr visit.....sometimes her pain is debilitating, sometimes just annoying, but always there.

 

She is a cheerleader, so when the pain first started, it was presumably a normal injury.  Possible sprain/strain, over use etc.

 

PT for 4 months didn't help (excellent PT who worked on her core and back)

Mri showed a slight bulge in L4-L5 but no nerve impingement, so they don't think this is the problem.

XRay- clear

Bone Scan- clear.

 

Physiatrist suspected a Pars fracture/ compression fracture, had her completely rest her back for 6+ weeks (no cheer and no activity that wasn't absolutely necessary) over Christmas break.  She feels fine laying down, but then hurt the more she moves around.    MRI and bone scan cleared both issues from possible sources of pain.

 

She has 2 PCP (right between seeing a pediatrician and adult internal med doctor).  Neither have any idea why she is hurting. They are both the type of doctor to refer out to specialists. 

 

She is hyper-flexible, so there is a slight possibility that she has a connective tissue disorder.  

 

Her physiatrist/orthapedist/sports medicine doctor was moving at the end of February so he wouldn't be seeing her any more after the bone scan.  He is the one who referred her to the Rheumatologist.   I have sjogrens, her dad has psoriasis, her aunt has RA, so there is an increased risk for her to have a rheum issue also.

 

The Rheumatologist feels that the referral was appropriate, but also says he doesn't see anything glaringly obvious. He requested the blood work, and requested another MRI with contrast to rule out a few other rheum issues.  We haven't done that yet.  The Rheum was the one who handled it oddly.  Instead of placing the blood work himself, and ordering the MRI, he gave me a list for the PCP to order.   He said he wanted to see her in 4 months no matter what, and if there was something that came up in the blood work or MRI, he would call and schedule a more immediate appt.  The rheum also wants her seen by an orthopedist, but instead of doing the referral himself , again he is putting it back on the PCP to do the work.  The PCP has only seen her one time for this issue, because everything has been handled by the specialists. 

 

So her PCP, was kinda forced to get all the authorizations and to compile the results in stead of the rheum dr.  The rheum dr even said that if the PCP didn't want to keep looking for answers for her pain, that he would oversee the care. So why? would he make the PCP write all the orders?  The PCP is in a very small medical practice of half a dozen doctors....the rheum is part of a huge, mulitstate practice, so it isn't like he doesn't have the staff to do the work for him.