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What Do These Following Lab Reports Indicate?
Question: Hi ,
I have been having some symptoms for last couple of years. my symptoms include and have numbered it the order they started
1) Pins and needles all over the body
2) GERD Heartburn
3) Right leg stiffness
4) Twitches all over the body ( which has reduced now), mycolonus jerks (while falling asleep)
5) Tremors when a muscle is in use
6) stiffness in neck
7) Random pain all over the body (i believe its my muscle /tendons etc..) but it happens mostly near the joint are when streched . I am not sure if i can call it as a joint pain
8) Pain on the left side of the neck
9) my whole body feels stiff (especially the muscles)
Now, with all these . I have some vision problem, lighheadedness and feeling dizzing when i move eyes or make any suddent movements. I also feel very sensitive to light and sounds.
Doctors visit.
I have seen almost 4-6 nuerologist and they cant find anything wrong with me, I have had XXXXXXX scan (nothing significant), spine MRI (facet arthopathy / face fracture at l5 -s1), neck ct (nothing significant), abdomen KUB scan (mild lumbar scoliosis).
Gastro for heartburn ,endoscopy revealed hiatal hernia and gastritis.
Lastly, i did some analysis and got the docs to do a autoimmune test. ANA positive and anti rnp positive. I will attach the lab reports for further reviewing. I saw a rhuematologist and she was inconclusive because of the symptoms i had. What could it be?? my GP said anti rnp is seen in people with MCTD and 40% with lupus. What could mine be? Should i get any additional tests done?
I have been having some symptoms for last couple of years. my symptoms include and have numbered it the order they started
1) Pins and needles all over the body
2) GERD Heartburn
3) Right leg stiffness
4) Twitches all over the body ( which has reduced now), mycolonus jerks (while falling asleep)
5) Tremors when a muscle is in use
6) stiffness in neck
7) Random pain all over the body (i believe its my muscle /tendons etc..) but it happens mostly near the joint are when streched . I am not sure if i can call it as a joint pain
8) Pain on the left side of the neck
9) my whole body feels stiff (especially the muscles)
Now, with all these . I have some vision problem, lighheadedness and feeling dizzing when i move eyes or make any suddent movements. I also feel very sensitive to light and sounds.
Doctors visit.
I have seen almost 4-6 nuerologist and they cant find anything wrong with me, I have had XXXXXXX scan (nothing significant), spine MRI (facet arthopathy / face fracture at l5 -s1), neck ct (nothing significant), abdomen KUB scan (mild lumbar scoliosis).
Gastro for heartburn ,endoscopy revealed hiatal hernia and gastritis.
Lastly, i did some analysis and got the docs to do a autoimmune test. ANA positive and anti rnp positive. I will attach the lab reports for further reviewing. I saw a rhuematologist and she was inconclusive because of the symptoms i had. What could it be?? my GP said anti rnp is seen in people with MCTD and 40% with lupus. What could mine be? Should i get any additional tests done?
Brief Answer:
Anti RNP antibody
Detailed Answer:
Good evening
Thank you for writing on health care magic
I have gone through your history and the lab reports.
you do have different spectrum of symptoms which are not fitting into 1 disease, that is the reason no one is able to give you the diagnosis.
Among st the neurological symptoms, I would advise to get an EMG NCV test done. It is used to check for any neuropathy considering the tingling and numbness you are observing throughout. That is the only test left among the neurological side.
As for your RNP antibody, at present you dont have any symptoms to label you as Lupus or MCTD. RNP antibody are of many times. I am not sure which one they have performed, if it is U 1 RNP or U 3 RNP or Sm/RNP as all of them carry a different significance and are present in different diseases. Your ANA is mildly positive as well. But these titres in a male are significant. But at present we can wait and repeat these tests after 3 months. There is a chance the disease may evolve over time and more antibodies can come positive or they may not evolve and be present like that.
Even with the antibody positivity and no symptoms, we prefer not treating it and keeping it under close watch.
To co relate things, ANA positive with any finding on NCV studies does hold a significance as ANA can cause inflammation in the nerves in a patchy manner. So we need to exclude that out. So that is one thing I would be keen on getting it done.
You can discuss the option with your GP and let me know what he says
I hope the information was useful and didnt confuse you
Do let me know for more queries
Would be happy to help out
Regards
Dr Naval
Anti RNP antibody
Detailed Answer:
Good evening
Thank you for writing on health care magic
I have gone through your history and the lab reports.
you do have different spectrum of symptoms which are not fitting into 1 disease, that is the reason no one is able to give you the diagnosis.
Among st the neurological symptoms, I would advise to get an EMG NCV test done. It is used to check for any neuropathy considering the tingling and numbness you are observing throughout. That is the only test left among the neurological side.
As for your RNP antibody, at present you dont have any symptoms to label you as Lupus or MCTD. RNP antibody are of many times. I am not sure which one they have performed, if it is U 1 RNP or U 3 RNP or Sm/RNP as all of them carry a different significance and are present in different diseases. Your ANA is mildly positive as well. But these titres in a male are significant. But at present we can wait and repeat these tests after 3 months. There is a chance the disease may evolve over time and more antibodies can come positive or they may not evolve and be present like that.
Even with the antibody positivity and no symptoms, we prefer not treating it and keeping it under close watch.
To co relate things, ANA positive with any finding on NCV studies does hold a significance as ANA can cause inflammation in the nerves in a patchy manner. So we need to exclude that out. So that is one thing I would be keen on getting it done.
You can discuss the option with your GP and let me know what he says
I hope the information was useful and didnt confuse you
Do let me know for more queries
Would be happy to help out
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your answer.
As for the EMG/NCV , I had NCV done a a year back i believe on both my hands and they did not show any issues. As for the numbness its not much as there as i described, like when i elbow in pressed the ulnar nerve gets pressed easily and like when i sit for a long time one my feet gets numb and usually goes off when i stand. The pins and needles that i had mentioned also has subsided a lot, either i have got used to it else i dont feel it anymore as i used too.
I had one anti RNP and SM antibody test a couple of weeks back and it still shows >0.8 for rnp and SM antibody is still negative.
As you have mentioned, that i need to keep a close watch and possibility that i might have MCTD or lupus in the future. What are the few things that i needs to keep track of as for my blood test goes.
Can you give a detail list of the blood work that i have to repeat to keep track of this problem? Also i heard that lupus or mctd can affect organs, should i be concerned at this point , i have shortness of breath(when i get up and i can feel my heart beat) and dizziness when i move around fast this could also be caused by my vision issues that im having but not sure. can you comment on this as well please?
If you had to name this, not that i want you too but does my symptoms go in hand with fibro can ppl with fibro have anti rnp
As for the EMG/NCV , I had NCV done a a year back i believe on both my hands and they did not show any issues. As for the numbness its not much as there as i described, like when i elbow in pressed the ulnar nerve gets pressed easily and like when i sit for a long time one my feet gets numb and usually goes off when i stand. The pins and needles that i had mentioned also has subsided a lot, either i have got used to it else i dont feel it anymore as i used too.
I had one anti RNP and SM antibody test a couple of weeks back and it still shows >0.8 for rnp and SM antibody is still negative.
As you have mentioned, that i need to keep a close watch and possibility that i might have MCTD or lupus in the future. What are the few things that i needs to keep track of as for my blood test goes.
Can you give a detail list of the blood work that i have to repeat to keep track of this problem? Also i heard that lupus or mctd can affect organs, should i be concerned at this point , i have shortness of breath(when i get up and i can feel my heart beat) and dizziness when i move around fast this could also be caused by my vision issues that im having but not sure. can you comment on this as well please?
If you had to name this, not that i want you too but does my symptoms go in hand with fibro can ppl with fibro have anti rnp
Brief Answer:
Anti RNP antibody and MCTD
Detailed Answer:
Good evening
Sorry for the late reply...Had a long duty and just got free
1. Well it is good that your symptoms are better with the tingling and numbness. If NCV was normal, there is nothing you need to be worried about with the nerve issues. Make sure your Vitamin B 12 and Vitamin D levels are adequate as well
2. For the MCTD/Lupus, it is very rare in males to happen. But since your antibody has come out positive an observation is necessary. You should repeat your ANA and ENA profile once more after 3 months to see the titres if they are rising or if any new antibody has come up.
For the organ involvement, do get your complete blood counts, kidney function tests and urine routine 3 monthly. We should observe it for 2-3 readings to be sure the disease is not evolving.
3. For shortness of breath, if i relate it to your Anti RNP antibody I would recommend to get a 2 D Echo done as this antibody does increase the Pulmonary artery pressures of the heart. TO be sure the symptoms you are experiencing are not pathogenic, this is one test we should get it done and rule it out. It can explain the symptoms you are experiencing. But then again , it may not be too significant. Never the less, we can exclude it
4. Fibromyalgia is a diagnosis of exclusion and 20 % of patients with fibro do have ANA positive. Anti RNP is usually not seen. But at times, our body does produce false antibody as well. But repeat it after 3 months to be sure it is positive or not. Dont stress out your life on it as stress makes the issues worse.
5. One school of thought is to start hydroxychloroquine as it slows the conversion of ANA to full blown disease. But I still feel we can wait as you are having vision issues as well. If it is positive after 3 months as well, we can consider starting on it. It is a safe medicine and whatever benefit it does, it can slow down the disease evolution
I hope the information was useful
Do let me know for more queries
Would be happy to help out
REgards
Dr Naval
Anti RNP antibody and MCTD
Detailed Answer:
Good evening
Sorry for the late reply...Had a long duty and just got free
1. Well it is good that your symptoms are better with the tingling and numbness. If NCV was normal, there is nothing you need to be worried about with the nerve issues. Make sure your Vitamin B 12 and Vitamin D levels are adequate as well
2. For the MCTD/Lupus, it is very rare in males to happen. But since your antibody has come out positive an observation is necessary. You should repeat your ANA and ENA profile once more after 3 months to see the titres if they are rising or if any new antibody has come up.
For the organ involvement, do get your complete blood counts, kidney function tests and urine routine 3 monthly. We should observe it for 2-3 readings to be sure the disease is not evolving.
3. For shortness of breath, if i relate it to your Anti RNP antibody I would recommend to get a 2 D Echo done as this antibody does increase the Pulmonary artery pressures of the heart. TO be sure the symptoms you are experiencing are not pathogenic, this is one test we should get it done and rule it out. It can explain the symptoms you are experiencing. But then again , it may not be too significant. Never the less, we can exclude it
4. Fibromyalgia is a diagnosis of exclusion and 20 % of patients with fibro do have ANA positive. Anti RNP is usually not seen. But at times, our body does produce false antibody as well. But repeat it after 3 months to be sure it is positive or not. Dont stress out your life on it as stress makes the issues worse.
5. One school of thought is to start hydroxychloroquine as it slows the conversion of ANA to full blown disease. But I still feel we can wait as you are having vision issues as well. If it is positive after 3 months as well, we can consider starting on it. It is a safe medicine and whatever benefit it does, it can slow down the disease evolution
I hope the information was useful
Do let me know for more queries
Would be happy to help out
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for taking time off on you busy scheduling and answering my questions.
I do realize at this point by titers and symptoms are not leading to an MTCD or Lupus diagnosis. Based on the blood work that i have done, do you think there is any additional blood work that can be done to give a more specific diagnosis or are they good enough?
At one point in time i had low vitamin D low as around 20 i guess but then i started taking supplement and they were normal again. I do take them once in awhile usually during winter season. I have never checked by Vitamin B12 , may be thats something that i can ask my GP to do.
One question, I do have a lot of stomach issues (heartburn, gas pain, diahreaa) but GP wouldnt check me for anything and just name it as IBS , GERD. I did have a endoscope done and it showed gastritis and hiatal hernia. Could there be any bowel disease that can make positive antibodies (Like Celiac or Chrons). Do you think i should pursue further investigation with my gastro on this or just rely on the fact its just IBS and deal with it.
Also, as mine has evolved into anything that could be treated with medication at this point. Are there any supplments that you would suggest your patients to take? For me its mostly muscle pain and stiffness that are causing the most discomfort ( i take probiotics , fish oil and joint support (MSM&Glucosmaite) for now). Any other supplement that would benefit me? ( like CoQ10 or Alpha lipoic acid or ??)
I do realize at this point by titers and symptoms are not leading to an MTCD or Lupus diagnosis. Based on the blood work that i have done, do you think there is any additional blood work that can be done to give a more specific diagnosis or are they good enough?
At one point in time i had low vitamin D low as around 20 i guess but then i started taking supplement and they were normal again. I do take them once in awhile usually during winter season. I have never checked by Vitamin B12 , may be thats something that i can ask my GP to do.
One question, I do have a lot of stomach issues (heartburn, gas pain, diahreaa) but GP wouldnt check me for anything and just name it as IBS , GERD. I did have a endoscope done and it showed gastritis and hiatal hernia. Could there be any bowel disease that can make positive antibodies (Like Celiac or Chrons). Do you think i should pursue further investigation with my gastro on this or just rely on the fact its just IBS and deal with it.
Also, as mine has evolved into anything that could be treated with medication at this point. Are there any supplments that you would suggest your patients to take? For me its mostly muscle pain and stiffness that are causing the most discomfort ( i take probiotics , fish oil and joint support (MSM&Glucosmaite) for now). Any other supplement that would benefit me? ( like CoQ10 or Alpha lipoic acid or ??)
Brief Answer:
Further queries
Detailed Answer:
Good evening
Pertaining to your query:
1. As of now, the blood tests are still quite limited to determine the evolution of connective tissue disease like SLE or MCTD. These are the ones which are usually used to monitor and prognosticate. I am not sure if any new ones have come up in US, but so far you have done the standard ones and these suffice.
2. For vitamin D you should continue taking it as the levels drop once you stop the medicine. Food stuffs are not rich in Vitamin D, hence we need to supplement it from the top.
3. For your bowel symptoms, Celiac disease can produce false ANA and it can be associated with Lupus also. But the gold standard is abstinence from GLuten in your diet. You can plan for a colonoscopy with biopsy if symptoms are too bad, or just try a gluten free diet to see if symptoms get better. Crohns is a more severe variant and would have caused blood in stools and other problems. So it is less likely to be crohns. I would still put IBS as the first diagnosis. You need to de stress yourself and take lot of fibers in the diet. Half an hour exercise daily should improve the bowel symptoms as well.
4. As for muscles aches and pain, again Vitamin D levels maintained in a normal range would help. It s deficiency is known to increase the muscle aches and joint pains.
As for antioxidants, it is still controversial whether it will help or not. Rather than tablets, I would suggest you go for the natural ones...That is a diet rich in Vitamin C as it is the best antioxidant. Also include tomatoes in your food along with Pomegranate. They have the highest anti oxidant content.
Just to mention: I hope you dont smoke as smoking is one risk factor which aggravates the progression of these connective tissue disease by 5 times.
I hope the information was useful
Do let me know for more queries..WOuld be happy to sort it out
regards
DR Naval
PS: it is my pleasure to help you out
Further queries
Detailed Answer:
Good evening
Pertaining to your query:
1. As of now, the blood tests are still quite limited to determine the evolution of connective tissue disease like SLE or MCTD. These are the ones which are usually used to monitor and prognosticate. I am not sure if any new ones have come up in US, but so far you have done the standard ones and these suffice.
2. For vitamin D you should continue taking it as the levels drop once you stop the medicine. Food stuffs are not rich in Vitamin D, hence we need to supplement it from the top.
3. For your bowel symptoms, Celiac disease can produce false ANA and it can be associated with Lupus also. But the gold standard is abstinence from GLuten in your diet. You can plan for a colonoscopy with biopsy if symptoms are too bad, or just try a gluten free diet to see if symptoms get better. Crohns is a more severe variant and would have caused blood in stools and other problems. So it is less likely to be crohns. I would still put IBS as the first diagnosis. You need to de stress yourself and take lot of fibers in the diet. Half an hour exercise daily should improve the bowel symptoms as well.
4. As for muscles aches and pain, again Vitamin D levels maintained in a normal range would help. It s deficiency is known to increase the muscle aches and joint pains.
As for antioxidants, it is still controversial whether it will help or not. Rather than tablets, I would suggest you go for the natural ones...That is a diet rich in Vitamin C as it is the best antioxidant. Also include tomatoes in your food along with Pomegranate. They have the highest anti oxidant content.
Just to mention: I hope you dont smoke as smoking is one risk factor which aggravates the progression of these connective tissue disease by 5 times.
I hope the information was useful
Do let me know for more queries..WOuld be happy to sort it out
regards
DR Naval
PS: it is my pleasure to help you out
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your response .
This is probably the last question , yesterday I had extreme in dizziness while at sleep ( sleeping on my side ) I had vertigo waking up an seven going back to sleep . I went to the doctors yesterday and they told me its BPPV can this be because of the evolving MCTD or could this me something isolated . I did the eley mauvuer and have been prescribed some antivert have been feeling ok since then but again looks like still have a little bit of it going on . It's surprising to see what all issues I get and its scary . I usually try not to worry but have been stressing about it for the last couple of days .
I really appreciate your help ..
This is probably the last question , yesterday I had extreme in dizziness while at sleep ( sleeping on my side ) I had vertigo waking up an seven going back to sleep . I went to the doctors yesterday and they told me its BPPV can this be because of the evolving MCTD or could this me something isolated . I did the eley mauvuer and have been prescribed some antivert have been feeling ok since then but again looks like still have a little bit of it going on . It's surprising to see what all issues I get and its scary . I usually try not to worry but have been stressing about it for the last couple of days .
I really appreciate your help ..
Brief Answer:
Delayed response
Detailed Answer:
Good evening
Sorry for the delayed response. Had a long 24 hour duty..
Firstly, feel free to clear as many doubts you have. As long as it makes your life better, I would be glad to help you out
Secondly, BPPV is normally not related to your evolving MCTD. It is a very common problem and can happen in any person, usually self limiting. I hope it is already better.
Well, I would suggest not to relate lot of daily events to MCTD. Or else life will be very stressful. All of us go through lot of ups and downs which are common in every person.
PS: You still dont have MCTD yet. So carry on with your life as normally as you can...
The warning signs which you need to look out for:
1. Joint swelling
2. Oral ulcers
3. Papular rashes over the body
4. Chest Pain
5. Shortness of breath
I hope the information was useful
DO let me know for more doubts
REgards
Dr Naval
Delayed response
Detailed Answer:
Good evening
Sorry for the delayed response. Had a long 24 hour duty..
Firstly, feel free to clear as many doubts you have. As long as it makes your life better, I would be glad to help you out
Secondly, BPPV is normally not related to your evolving MCTD. It is a very common problem and can happen in any person, usually self limiting. I hope it is already better.
Well, I would suggest not to relate lot of daily events to MCTD. Or else life will be very stressful. All of us go through lot of ups and downs which are common in every person.
PS: You still dont have MCTD yet. So carry on with your life as normally as you can...
The warning signs which you need to look out for:
1. Joint swelling
2. Oral ulcers
3. Papular rashes over the body
4. Chest Pain
5. Shortness of breath
I hope the information was useful
DO let me know for more doubts
REgards
Dr Naval
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Sonia Raina
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