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What Does My Lab Test Report Indicate?

Posted on Tue, 9 Aug 2016

Question: I have lab test back and RF serum is positve ( 12.6) and all other labs are normal, do I have RA?
aCBC W/ AUTO DIFF
From the provider: Normal white blood cell count, normal platelets, no anemia.
C-REACTIVE PROTEIN, QUANTITATIVE
From the provider: normal inflammatory marker
HBA1C (HEMOGLOBIN A1C), BLOOD
From the provider: No diabetes
VITAMIN B12 + FOLATE, SERUM OR BLOOD
From the provider: b12 and folic acid with in normal limits.
VITAMIN D, 25-HYDROXY, TOTAL, SERUM
From the provider: Normal Vitamin D level
RF (RHEUMATOID FACTOR), SERUM
From the provider: rheumatoid factor is positive. This was the only marker that was positive. As discussed at...
CCP (CYCLIC CITRULLINATED PEPTIDE) IGA+IGG, SERUM
From the provider: negative rheumatoid arthritis marker.
ESR (ERYTHROCYTE SEDIMENTATION RATE), BLOOD
From the provider: normal inflammatory marker
CMP, SERUM OR PLASMA
From the provider: Normal blood glucose, normal kidney and liver function, electrolytes with in normal limits
URIC ACID, SERUM OR PLASMA
From the provider: normal uric acid
TSH, SERUM OR PLASMA
From the provider: Normal thyroid function
LIPID PANEL, SERUM
From the provider: cholesterol panel with in normal limits.

Answered by Dr. Naval Mendiratta (4 hours later)

Brief Answer:
Rheumatoid Arthritis

Detailed Answer:
Good evening

Thank you for writing on health care magic

Well, your rheumatoid factor is only mildly positive...Most labs have a cut of between 8-12...SO it is only mildly positive..

Something I would like to put forward here...

1. I would like to know why were the test carried out...??DO you have any joint swellings and pain..If yes which joints are affected?

2. Do you experience early morning stiffness?

3. ANy history of dry eyes and dry mouth??

4. Any history of oral ulcers/hair fall/Rashes/photosenstivity...?

TO label the person as Rheumatoid arthritis, history and clinical examination is sufficient...RA factor is only supportive...So, if you have significant joint swelling and pain, with a negative RF, we will still call it as Seronegative arthritis and treat you...However if there is no joint swelling seen, and ESR and CRP are normal( in your case) along with Anti CCP, we still wont call it as rheumatoid arthritis even if the RF came out to be 120....RF can be false positive in 10 % of the normal population..It can also be positive in Hypothyroid patients...

SO if there is no associated swelling/Early morning stiffness I wont label it as Rheumatoid Arthritis. DO let me know these queries... Would like to see if you have other forms of arthritis where RF can be positive

Hope the information was useful

Do let me know for more queries

REgards
Dr Naval

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naval Mendiratta (54 minutes later)

I have bilateral joint pain in fingers and knees, Im starting to see fine motor skills of fingers diminished. limited ROM in fingers, morning stiffness in hands and feet. pain does not go away though it is diminished. Meloxicam doesn't seem to help. hip pain usually on one side high up where neck meets the skull. feet are both painful, leg and feet swelling. unusual fatigue, muscle weakness. changes in vision, not sure if you call it dry eyes, but eyes feel sticky almost. Occasional dry mouth and involuntary upper lip and brow twitch

Answered by Dr. Naval Mendiratta (15 hours later)

Brief Answer:
Is it a connective tissue disease

Detailed Answer:
Good evening

Sorry for the delayed reply..Just got free from duty

Well, the symptoms do point towards some form of arthritis going on. But yes the pain killers dont seem to work in your case...

So a couple of things I would advise you to evaluate

1. Since you have sticky eyes, fatigue, joint pains it is important we get an ANA done...ANA will give us an idea if it is a connective tissue disease, where RF can be vaguely positive as well..

2 . Ultrasound of the joints should be our next step..It will tell us whether there is inflammation going on or it some other form of pain troubling you

3. If all of it is negative, our last working diagnosis would be Fibromyalgia... FAtigue, bodyache, weakness, decreased sleep, irritability, forgetfulness all can be a part of it.. But that would be our last diagnosis...

I hope the information was useful

Do let me know for more queries. Would be happy to guide you further

Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naval Mendiratta (3 hours later)

I'm sorry, I thought I had copied that result to you. ANA was negative. A CCP Antibodies IgG/IgA was done results is 2. an xray was done of both hands:

FINDINGS:
Left hand: No fracture or dislocation is present. Bone mineralization is
normal. There is a small
well-circumscribed 6 mm x 2 mm lucent lesion within the third metacarpal head.
No evidence of soft tissue
swelling or periarticular erosion seen. Carpal bones are normal. Distal radius
and ulna also are normal.

Right hand: No fracture or dislocation is present. No focal bone lesion is
present. Soft tissues are
normal. Distal radius and ulna are normal..

IMPRESSION:
1. Normal right hand.
2. Subcentimeter well-defined benign-appearing cystic lesion in the left third
metacarpal head. This
could represent a benign cyst or potentially a small enchondroma. Consider
further evaluation with the
MRI.

You recommend an ultrasound. This xray report recommends MRI. Will either one show the inflammation? or is one better than the other?

Answered by Dr. Naval Mendiratta (9 hours later)

Brief Answer:
Ultrasound

Detailed Answer:
Good evening

Well, the lucency may just be a ganglion and it may not be the cause of pains you are experiencing in all the joints...

I personally would suggest an ultrasound as it can screen more joints than MRI would...The hands, feet, elbows everything can be screened for the inflamamtion. With MRI the limitation is that they will be able to perform a limited study only..So we may miss out on the other areas...

Both are equally good, provided an experienced person is doing the ultrasound...They both are equally sensitive...

Do let me know the results...

Regards
Dr naval

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar