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Tuesday, January 14, 2014

My Rheumatoid Arthritis Story - Part 5

Before I had my follow-up appointment I was notified that test results had been posted to My Chart. My Chart is a service of Carilion where you create an account which allows you to view your medical record. That includes future appointments, tests that are due, test results, and an email option where you can get in touch directly with your doctor. It's a very useful and practical service that certainly beats me having to badger a nurse to please send the results to me as soon as possible.

I started to read the results and began to wonder if perhaps I was reading them wrong. Some of the findings just didn't make sense to me. I am going to share some of them with you now:

Xrays of foot - "3 views of each foot. Preservation of joint spaces and bone density with no evidence of periarticular demineralization or marginal erosion. No definite periarticular soft tissue swelling. No acute fracture or osseous malalignment. No abnormal soft tissue calicifications. Mild right 1st metacarpophalangeal osteoarthrosis."
Impression: No features of an erosive arthropathy in either foot.
Comments from the doctor's office: Your xrays look fine.

Xrays of hand - "3 views of each hand. Preservation of joint spaces and bone density with no evidence of periarticular demineralization or marginal erosion. No definite periarticular soft tissue swelling. No acute fracture or osseous malalignment. No abnormal soft tissue calicifications. Corticated ossicle adjoining the left ulnar styloid process and a subtle corticated irregularity along the ulnar aspect of the distal left diaphysis suggesting old trauma."
Impression: No features of an erosive arthropathy in either foot.
Comments from the doctor's office: Your xrays look fine.

The "old trauma" would probably stem from when I was a pre-teen. I remember slipping and falling on the ice and hurting my left wrist/arm. I swore I had broken it, but nobody believed me. I never went to the doctor for it, and had an Ace Bandage as my therapy. To this day most times I can tell when it's going to rain because it hurts.

Notice how both xrays do not mention rheumatoid arthitis at all, and my foot mentions minor osteo arthritis.

Hepatatic Function Panel - All levels were within normal range except for the ALT which was only slightly elevated. I do not have hepatitis B or C.
Note the comparison of numbers between the two labs as well as the Standard Range each one uses:

Carilion - AST - Mine - 31. Standard Range - 10-42 ALT - Mine 66. Standard Range 10-60
Dr. DoNothing's Clinic - AST -  Mine - 44. Standard Range 15-37 ALT - Mine -106. Standard Range 30-65

There is quite a difference not only between the two labs, but between their Standard Range.

According to the 2010 ACR Classification Criteria for scoring/diagnosing Rheumatoid Arthritis, the following four tests are used:

Sedimentation Rate - Mine - 12. Standard Range 0-30.

The sedimentation rate (sed rate) blood test measures how quickly red blood cells (erythrocytes) settle in a test tube in one hour. The more red cells that fall to the bottom of the test tube in one hour, the higher the sed rate.

When inflammation is present in the body, certain proteins cause red blood cells to stick together and fall more quickly than normal to the bottom of the tube. These proteins are produced by the liver and the immune system under many abnormal conditions, such as an infection, an autoimmune disease, or cancer.

The normal rate for a woman is 0-20. I have 12.

CCP AB IGG - Mine - less than 2. Reference range: 0.0 to 5.0 Interpretive Table: Low Positive: 5.1 - 14.9. High Positive - more than 15.

Citrulline antibody is an immune protein (antibody) that binds to a non-standard amino acid (citrulline) that is formed by removing amino groups from the natural amino acid, arginine. Citrulline antibodies are measured with a blood test that is analyzed in laboratories.

Research suggests that in the joints of patients with rheumatoid arthritis, proteins may be changed to citrulline as part of the process that leads to inflammation of the rheumatoid joint. Citrulline antibody has also been referred to as anti-citrulline antibody, anti-cyclic citrullinated peptide antibody, and anti-CCP. A plasma protein that rises in the blood with the inflammation from certain conditions.

My antibody was less than 2, way under the low positive of 5.1 - 14.9.

C-Reactive Protein - Mine - 0.44. Standard Range less than 1.0

C-reactive protein (CRP) is one of the plasma proteins known as acute-phase proteins: proteins whose plasma concentrations increase (or decrease) by 25% or more during inflammatory disorders.

CRP can rise as high as 1000-fold with inflammation. Conditions that commonly lead to marked changes in CRP include infection, trauma, surgery, burns, inflammatory conditions, and advanced cancer.

.44 is less than 1.

And for the main event:

Rheumatoid Factor - Mine is less than 10. Reference range: less than 14. Interpretive Table Low Positive: 15 - 41. High Positive: above 42.

Rheumatoid factor is an antibody that is detectable in the blood of 80% of adults with rheumatoid arthritis.

Rheumatoid can be detected in the blood of normal individuals and of those with other autoimmune diseases that are not rheumatoid arthritis.

In people with rheumatoid arthritis, high levels of rheumatoid factor can indicate a tendency toward more aggressive disease and/or a tendency to develop rheumatoid nodules and rheumatoid lung disease.

Normal is under 15. I have less than 10.

Now I don't have a medical degree, and I didn't stay in a Holiday Inn Express last night, but I know how to read. Unless I'm in Opposite World the results of my tests all point that I do NOT have Rheumatoid Arthritis.

What...the...fuck?



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