General Rheumatology

When the anti-CCP antibody is negative

November 4, 2021 ·

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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Mixed Connective Tissue Disease

October 26, 2021 ·

It is rare for someone to get a diagnosis of Mixed Connected Tissue Disorder (MCTD) right away. Most people bounce around from specialist to specialist, collecting diagnoses before they are finally diagnosed with MCTD. This, understandably, leads to confusion and some trust issues. How could it have taken so long to get to a diagnosis? How can you be sure it’s MCTD?

And patients aren’t the only ones confused. Doctors, especially non-rheumatologists, can be confused by MCTD, opting to use the short-hand “lupus.” In many instances, that may be ok, but for the Rheumatologist, and patient, the distinction is important.

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Complements & Lupus

October 21, 2021 ·

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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Why everyone asks if you are depressed

September 21, 2021 ·

I’m not depressed!

And besides, wouldn’t you be if you were in pain all the time?

I know this conversation all too well. It is a conversation that takes longer than the 15 minutes we are given with our doctors. Why do doctors keep bringing this up? We worry that talking about our emotional state could label us. Doctos will assume it’s all in our head and our concerns and symptoms will no longer be taken seriously. These concerns are valid as I’ve, unfortunately, seen issues go unchecked in patients where too many assumptions were made. But despite this real concern, we shouldn’t dismiss the opportunity to investigate the way emotions may be impacting our symptoms.

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Get to know the anti-centromere antibody

September 14, 2021 ·

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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