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Austin from Toronto asks: I tested CCP positive but have no symptoms of rheumatoid arthritis. Am I more likely to get it now?
Anti cyclic citrullinated peptide (anti CCP) is a test which is highly associated with rheumatoid arthritis. It is not necessary to test positive to have rheumatoid arthritis, but most individuals who are positive have or will develop RA. That being said, there are exceptions to this rule, particularly if the test is not strongly positive. In particular, there is growing data to suggest individuals with pulmonary (lung) issues may test positive and not develop RA. In some instances, it may be worthwhile monitoring your joints with a rheumatologist over time to ensure you do not develop rheumatoid arthritis.
Mahdi from Afghanistan asks: My wife was told she has Takayasu’s arteritis, but her tests (ESR, CRP) came back normal. Is this possible?
Takayasu’s arteritis is a form of vasculitis. It is unique in that it affects large blood vessels, and is generally diagnosed in individuals under the age of 40. It causes inflammation in the blood vessels, which can disrupt blood flow, or cause the wall of the blood vessel to become thinner than it should. While markers for inflammation in blood tests can often be elevated in most forms of vasculitis, it is also possible for them to be normal. A normal test does not rule out Takayasu’s arteritis. While not for everyone, in some patients, a normal ESR or CRP may indicate that the disease is not currently active; damage has been done to the blood vessel causing blood flow disruption (no pulse), but smaller blood vessels have developed to provide the necessary blood flow in its place.
Cindy from Calgary asks: I tested positive for the ANA blood test. How can I get a confirmed diagnosis and treatment right away, if confirmed?
An ANA test is a non-specific test which may be associated with autoimmune diseases. In rheumatology, that means systemic lupus or other connective tissues diseases. An ANA test does not confirm a diagnosis. In fact, 10% of the general population has a positive ANA test and the majority – more than 95% of them – do not have and will never have lupus. To diagnose lupus or another connective tissue disease, it requires you and your doctor or rheumatologist to review your symptoms and overall health, complete a physical exam, and then pursue investigations based on that information.
Julie from Calgary asks: Does a negative test rule out ankylosing spondylitis?
As of 2017, there are no definitive blood tests which can diagnose or rule out ankylosing spondylitis. HLA B27 is a genetic marker which is often found in patients with AS, but it is not required to make a diagnosis. Similarly, inflammatory markers in the blood may be elevated in AS, but may also be normal. To make a diagnosis of ankylosing spondylitis, or to rule it out, a patient should review their story with their physician or rheumatologist. The rheumatologist often will obtain further imaging, including x-rays or an MRI of the lower spine, to help ascertain a diagnosis.
Steve from Charleston asks: Is an elevated CK a sign of inflammation?
CK, or Creatine Kinase, is an enzyme released by muscle in the body. When the muscle is being damaged, the amount of CK released increases. Some people always have a higher than normal CK, which may be fine for them. Some people have their CK rise after vigorous exercise, which for most individuals, is not a significant concern. CK can increase in diseases which cause inflammation in the muscle, but it is not a specific sign for inflammation. Rather, it only suggests something is happening the muscle, but not specifically what.
Karen from Calgary asks: Is it possible to have both osteoarthritis and rheumatoid arthritis?
Both osteoarthritis and rheumatoid arthritis can happen in the same person. Unfortunately, if you have one, it still is possible to have the other as well. It is important for you and your physician to be able to differentiate which joints are affected by which condition. The best way to do this is to describe to your physician which joints are involved and how they feel, while your physician will complete an appropriate physical exam. Further investigations such as blood tests or imaging can be helpful, they are often far from definitive in making a diagnosis on their own.
Making the right diagnosis ensures the right management choices are being made, as treatment for OA and RA are different. To learn more about OA and RA and treatment options, please click on the highlighted links above.
Anna from Port Alberni, BC asks: I really have no symptoms, but my doctor is concerned that I have mixed connective tissue disease because my RNP test is positive. What should I do?
Mixed connective tissue disease (MCTD) is similar and has some overlap to systemic lupus. By definition, an antibody test called RNP should be positive in MCTD. However, as in many conditions and tests in rheumatology, a positive test does not necessarily diagnose a disease. Conversely, a negative test does not always rule out a disease either. To truly make a diagnosis of MCTD, lupus, rheumatoid arthritis, or many other rheumatic diseases, your doctor/rheumatologist needs to review your personal history with you, complete a physical examination, review the appropriate tests and put all that information together to make an informed diagnosis.