question-icon

Have wrist pain, negative for rheumatoid factor. Had ITP and neutropenia. Why did nucleolar/homogeneous not indicate another disease?

default
Posted on Sun, 26 Aug 2012
Question: Hello,

I am a 36 year old female. About 10 years ago, I battled ITP (idiopathic thrombocytopenia purpura) and neutropenia. The ITP was severe, platelets eventually going to 1K. I had a positive XXXXXXX in 2003, 1:160. I basically went into remission over the next years. The XXXXXXX was negative in 2005. Recently in 2012, I began to have some arm pain in both wrists and went to the doctor, (the pain has currently gone away) I tested as follows: XXXXXXX 1:160 (homogenous, nucleolar), Anti-histone Antibodies (1.0, normal being 0 to .9) and CCP antibodies IgG/IgA (23, normal being 0 to 19). I was negative for rheumatoid factor and many of the other standard lupus/sjogren's tests. My platelets, WBC, etc are normal. Question: Rheumatologist recommends coming back in 3 months, no treatment or diagnosis are appropriate now. He says if anything, he would worry about rheumatoid rather than another disease. I don't completely understand why the nucleolar/homogenuous would not indicate I could have another disease. I do not completely understand if the CCP test can be a "false" positive or how unusual it is to test with a weak positive. I want to make sure that there is not something else I should be doing. It is almost like none of the tests paint the same picture or indicate the same disease. Thank you so much!

doctor
Answered by Dr. Divya Agarwal (10 hours later)
Hi XXXXXX,
From your history I gather that you were neutropenic and thrombocytopenic 10 years ago but subsequently went into remission. your XXXXXXX is positive and now you have pain in wrists.
I believe that this could be a picture of lupus. although at present you dont fit into the classification criteria.
But do let me know if you are photosensitive, do you have any abnormal reaction on the skin when you go out in the sun? Do you or have you ever in the past suffered from any rashes especially on the face? Is there any history of oral ulcers? Have you ever suffered from any form of pleurisy? Have you ever had a XXXXXXX vein thrombosis?
And lastly about your wrist pain, when is it worse- morning, afternoon or night. What makes it better? Do you suffer from any stiffness or swelling in the involved region.
Have you taken any pain killers for the same like paracetamol.

The anti CCP and RF are tests for rheumatoid arthritis, they may be positive or negative even if you have rheumatoid arthritis because there is an entity called seronegative rheumatoid arthritis. So it is more of a clinical diagnosis.
let me know about this and I will be happy to help.
Regards
Above answer was peer-reviewed by : Dr. Aparna Kohli
doctor
default
Follow up: Dr. Divya Agarwal (12 hours later)
Thank you. I am not necessarily photosensitive and don't have any skin reactions. Yes, I have oral ulcers on occassion. I sometimes have a sound that sounds like it is in the lungs if I laugh very hard, but no coughing or other lung involvement. I have never had XXXXXXX vein thromobosis. The wrist pain is not worse in the morning. I don't really have anything in particular that makes it stop...it just stops abruptly and then comes back a week or two later. There is nothing that appears to be swelling. I have not taken pain killers of any kind other than ibuprofen for headaches.

The CCP is a "weak" positive...could there ever be an explanation for that which is not an autoimmune issue? The doctor said I should retun in 3 months for followup...do you think I should be doing anything in the meantime?

Thank you!

doctor
Answered by Dr. Divya Agarwal (4 hours later)
Hi,

A low titre of anti CCP is less significant, it is a specific test for rheumatoid arthritis especially in high titres which means two times the limit of normal. So a low titre could be definitely false positive. And since you don't have any feature of inflammation in joints I think it is the correct strategy to wait and see how your joint disease progresses.

What you can do in the mean time is to exercise your joints, do some aerobic exercises like walking or jogging. The other thing is to quit smoking in case you do and take paracetamol for pain on as and when required basis.

I hope I have been helpful. Do write back in case you have more queries.

Regards

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
default
Follow up: Dr. Divya Agarwal (16 minutes later)
Thank you so much! I do not smoke and do not take any pain medication, but I do not exercise like I should, so I will start. Thank you again.
doctor
Answered by Dr. Divya Agarwal (1 hour later)
Hi,

Thanks for writing back.

Great, I am happy to be of help.

If you have no more queries for now, you may close the discussion and write a review.

Take care.
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
Answered by
Dr.
Dr. Divya Agarwal

Rheumatologist

Practicing since :1999

Answered : 659 Questions

premium_optimized

The User accepted the expert's answer

Share on
Have wrist pain, negative for rheumatoid factor. Had ITP and neutropenia. Why did nucleolar/homogeneous not indicate another disease?

Hi XXXXXX,
From your history I gather that you were neutropenic and thrombocytopenic 10 years ago but subsequently went into remission. your XXXXXXX is positive and now you have pain in wrists.
I believe that this could be a picture of lupus. although at present you dont fit into the classification criteria.
But do let me know if you are photosensitive, do you have any abnormal reaction on the skin when you go out in the sun? Do you or have you ever in the past suffered from any rashes especially on the face? Is there any history of oral ulcers? Have you ever suffered from any form of pleurisy? Have you ever had a XXXXXXX vein thrombosis?
And lastly about your wrist pain, when is it worse- morning, afternoon or night. What makes it better? Do you suffer from any stiffness or swelling in the involved region.
Have you taken any pain killers for the same like paracetamol.

The anti CCP and RF are tests for rheumatoid arthritis, they may be positive or negative even if you have rheumatoid arthritis because there is an entity called seronegative rheumatoid arthritis. So it is more of a clinical diagnosis.
let me know about this and I will be happy to help.
Regards