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High ANA Value, Joint Pain

Hi,

My Wife was previously diagnosed with Hypothyroidism which was successfully treated with Synthroid for some time.  A precursor to this was numerous miscarriages with no obvious cause, after taking matters into our own hands an endocrinologist diagnosed the condition and treated it resolving the painful repeated miscarriage concern completely.

Following the birth of our child, her tsh level has fluctuated a great deal, as is probably expected.  It has now mostly stabilized 9 months after, but, for several months she has been complaining of heavy joint pain especially in small joints (hands and fingers, etc), dizziness, fatigue.

Visiting a local GP for B.W. exhibited a very high ANA value.  This concerns me greatly, as they feel it is likely Rheumatoid Arthritis, not something anyone would want to be diagnosed with - let alone this young.  (She is 38 this month, with a 9 month old child to care for!).

Her values are as follows,

ANA:
Speckled: 1:320
Centromere: 1:320

Rheumatoid Factor 6 (<14 iu/ml)
T-4 Total 8.3 (4.5-12.5mcg/dl)
T-3 Free 292 (230-420 pg/dl)
TSH (3rd Generation?) 2.15 (.40-4.50 <- this lab seems to be using the range that got us in trouble previously ..)

The only other value that is high is Alkaline Phosphatase at 153.

Being that it will be some time before a specialist is able to discuss these values, I wanted to post a message here and see what type of professional feedback is available.  We attempted to make an appointment with our trusted Endocrine specialist who said they cannot assist with anything related to the ANA value, even though they were very helpful in the past.  An appointment has been made with a new Rheumatologist now.

My understanding is the ANA values shown, could be representative of the existing treatable condition.  (I would prefer that be the case over the alternatives!)

Where would you go from here?  What additional tests could be potentially ordered from a GP to help with diagnosing any potential problems sooner?
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Avatar universal
A negative test for rheumatoid factor, even in the presence of a strongly positive ANA, does not rule out RA. One report found that 7.5 percent of patients with RA were RF-negative and ANA-positive. The clinical manifestations of RA in such patients are similar to those seen in patients who are RF-positive (seropositive).

In addition to RA, patients with persistent polyarthralgias, a strongly positive ANA, and negative or low titer RF, may also have a different systemic connective tissue disease such as SLE, scleroderma, mixed connective tissue disease, or Sjögren's syndrome. Thus, these patients should undergo further clinical and serologic workup including tests for the following more specific autoantibodies:

    * Anti-DNA (SLE)
    * Anti-Sm (SLE)
    * Anti-RNP (mixed connective tissue disease)
    * Anti-centromere (limited scleroderma)
    * Anti-Topoisomerase 1 (SCL-70) (scleroderma)
    * Anti-Ro (Sjögren's syndrome)

Many of these patients develop clinical manifestations over a protracted period of time, thereby causing a long delay between the onset of symptoms and the diagnosis of disease. This can be very frustrating for both the patient and physician. A strongly positive ANA, particularly when accompanied by a positive test for a specific autoantibody, is objective evidence of an inflammatory process, and indicates that a systemic connective tissue disease may be evolving. A search for subtle signs of disease and additional testing are then warranted. The investigation may need to be ongoing until a definite syndrome can be diagnosed.
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Avatar universal
You could order a dsDNA which is reasonably specific for SLE.
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97953 tn?1440865392
MEDICAL PROFESSIONAL
The ANA is elevated and cannot likely be explained by a thyroid condition.  A rheumatology consult is the next step to determine the clinical significance of the ANA - these are usually treatable conditions.  The testing is very elaborate and should be coordinated by the rheumatologist.
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