Connected Rheumatology

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Auto-antibodies

When the anti-CCP antibody is negative

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Coming to a diagnosis of Rheumatoid Arthritis (RA) can be easy. We are spared months of bouncing between doctors and tests if we have the “right” symptoms and the “right” labs. Unfortunately, for many, the road to a RA diagnosis isn’t quite so quick. This is most commonly seen when the Rheumatoid Factor (RF) is positive but the anti-cyclic citrullinated peptide antibody (anti-CCP) is negative. 

As we’ve spoken about before, the RF antibody blood test is far from perfect. Despite its name, the Rheumatoid Factor is not specific for RA. In fact, it is seen in many other medical conditions (including the condition of “getting older”). Usually ordered with a RF (and if not with, then usually immediately afterwards) is the anti-CCP antibody. This antibody is MUCH more specific for RA and is seen in individuals years before developing RA symptoms. After 20+ years of practice, it is now standard of care to order an anti-CCP when concerned about RA. And our dependence on it can lead many to be confused when it returns negative.

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Complements & Lupus

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If you have ever seen a Rheumatologist or there has ever been concern for lupus, you most likely have had your complement 3 (C3) and complement 4 (C4) tested. Unfortunately doctors do not do a great job of explaining these tests or their results, but are more often than not, considered when your doctor is assessing whether your lupus is “active” or “quiet.”

The complement system is complex and most doctors, aside from rheumatologists and immunologists, do not remember the specifics of the “complement cascade.” But you don’t need a PhD in immunology to have a basic understanding of how complements work and what they can teach us about our body.

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Get to know the anti-centromere antibody

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The anti-centromere antibody rarely comes up in casual conversation. Even doctors are easily confounded by this antibody. Doctors can give confusing or mixed messages regarding a centromere antibody result and this can send even the most levelheaded into a tailspin.

What is a centromere?

We might need to return to high school biology to answer this. Stick with me as we do a quick refresher.  The centromere is a piece of DNA that attaches to chromatids to form a chromosome. (!!!) We all have 46 chromosomes or 23 pairs. (Think of “23 and me”) The chromosome is a structure that houses all our DNA. We find this structure in the nucleus of our cells, making, by definition, the centromere antibody an anti-nuclear antibody, or ANA. The anti-centromere antibody, thus, can be positive in those with a positive ANA result. Remember, the ANA blood test is a general, non-specific anti-nuclear antibody blood test while the anti-centromere antibody test is a more specific type of ANA. This then would make a positive centromere antibody result with a negative ANA, very unlikely.

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Know the Facts: Rheumatoid Arthritis (part 2)

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We’ve discussed what it is, who gets it and how we make a diagnosis (and if you missed it, check out our previous post). But WHY does this happen? And can it be avoided? Rheumatoid arthritis is truly life changing. Getting the right rheumatoid arthritis information and understanding how and why our bodies do this can help us gain back control.

So why Rheumatoid Arthritis? What causes it and why did this happen to you? Well, as with most things rheumatic, it’s complicated. Genetics most definitely plays a big role. Having a family member with RA will put everyone in the family at higher risk for developing, not only RA, but any autoimmune condition. This is why it’s so important to know your family history.

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Know the facts: Rheumatoid Arthritis (part 1)

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When getting a new diagnosis of Rheumatoid Arthritis, I find that most people need to start with the basics. It can be overwhelming. I know that not much beyond “You have Rheumatoid Arthritis” is heard and that everyone will need time to digest all the information out there.

So let’s talk about some Rheumatoid Arthritis facts and start with “What is Rheumatoid Arthritis?” RA is an autoimmune, systemic, inflammatory disorder. Seen in almost 1% of the US population, RA is more often seen in women compared to men and usually happens during middle age.

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