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Positive SCL-70 - Does it always mean Scleroderma - could it be Rheumatoid Arthritis?


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#1 kermodi

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Posted 04 October 2014 - 07:06 AM

Yesterday I got test results from my GP.

 

I have been experiencing joint pain in my thumbs and wrists.  X-rays showed Osteo arthritis in my hands - but the joint pain was coming on in 'flare ups' - so the doctor ran tests to rule out Rheumatoid Arthritis - which my paternal grandmother had bad - and my Dad had also.

 

(Don't know if it makes a difference - but I'm in Canada).

 

The only thing that was "off" in all the tests, she said - was the ANA score, which was positive.

 

Nuclear Ab/ANA:  5.0 (High)
(Moderate Positive 2.0-5.9)

 

There is nothing that shows any pattern - and no titre is shown either. (will require another appt with GP to get those values)

 

Because the ANA was positive the lab did a SCL-70 which was also positive, (among others tests which were all within range):
 

Scl-70 Ab 268 (<100) U/ml (High) Note: New Method (Multiple) and Reference Interval

 

There was also an Anti-CCP test done - but (strangely?) it says "For Physician Only" - and gives a number for the doctor to call to 'discuss results' with the pathologist.  I have no idea what that means - or why I cannot see the value.  (I understood Anti-CCP was pretty specific to RA?  My Rh factor was negative). 

 

Had I realized it, before I left the office, I definitely would have asked about it.

 

I have what I think is microcytic anemia (which I was told was a hallmark of RA):
Red Blood Count (H) - 5.2 (3.7-5.0)
MCV (L) - 76.2(28.3 - 33.5) fL(LOW)
MCH (L) - 25.8 (28.3 - 33.5) pg (LOW)
Platelets (L) - 144 (147 - 375) 10*9L (LOW)

 

 

My doctor was very serious - and very concerned about the Scl-70.

 

She has referred me to a Rheumatologist - though it will take 2 - 3 months to see her.

 

 I understand that the SCL-70 is pretty specific, but could it possibly indicate Rheumatoid Arthritis and not Scleroderma?

 

What are the percentages for 'false positives' with the SCL-70 anti-body test?

 

Are the 'new method multiplex' tests always accurate?

 

Exactly what kind of joint pain do you get with Scleroderma?

 

I'm so confused!

 

Please help?



#2 Amanda Thorpe

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Posted 05 October 2014 - 07:06 AM

Hello Kermodi

 

Welcome and let me say straight off that I can't give you a yes or no to all of your questions, I can say that there is no recognised autoantibody specific to rheumatoid arthritis. SCL-70 is only indicative of systemic scleroderma, specifically diffuse but ANA suggests a number of autoimmune diseases. Currently RF (rheumatoid factor) is the only real blood marker for RA (rheumatoid arthritis) but it's not a certainty.

 

Here's the problem with all the antibodies and so forth, they can only suggest a disease and their role in the diagnostic process should be to help confirm and categorise the disease. A diagnosis should be made using physical examination and clinical symptoms with blood work supporting the diagnosis or lack of but sometimes they can't even do that.

 

I have diffuse systemic scleroderma and throughout 7 long years my ANA, SCL-70 have always been negative, my rheumatoid factor negative, even my inflammatory markers are usually within normal ranges. If you put my blood work in front of a doctor not only would they say I did not have scleroderma but that I was perfectly healthy. Really? I have a bi ventricular ICD in situ thanks to scleroderma, don't give me healthy! Anyways the reverse is true, you can have bloodwork positive for scleroderma and never develop the disease.itself or even ever have a symptom.

 

So, I have no idea whether you have scleroderma or not and to muddy the waters even further, although scleroderma is not considered to be hereditary (apart from a specific type FPSS) autoimmune disease do seem to run in families. I know my ancestors had them (thanks!) as in Ma and Grandma but my identical twin doesn't? Go figure!

 

Finally it's my understanding that many a blood test turns up a false positive result, at least it's certainly been an issue for our friends in the US so I guess that must apply to us as well.

 

I am sorry but until you see your rheumatologist you won't know much of anything for sure. What I can say for sure is that should you go on to have scleroderma it is not the end of the world, just the world as you know it but then that's true of RA or any chronic, debilitating illness. Different doesn't mean bad and can actually mean better but you have to want to make it so.

 

Take care and keep posting.

 

PS I forgot to say there is no joint pain specific to scleroderma, although common, I didn't have any until about year 5.


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#3 Joelf

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Posted 05 October 2014 - 08:47 AM

Hi Kermodi,

 

Welcome to these forums!

 

Regarding your antibodies, I'm afraid I can't add anything to Amanda's advice; as she has stated, it's by no means straightforward to arrive at a diagnosis, not least because Scleroderma comes in so many different guises and can also mimic other diseases.

 

I've found another thread regarding Positive SCL-70, which I hope you'll find helpful and interesting.

 

Do let us know how you get on with your rheumatologist's appointment.

 

Kind regards,


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#4 Shelley Ensz

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Posted 07 October 2014 - 06:02 AM

Hi Kermodi,

 

Welcome to Sclero Forums!  I'm sorry you have such health issues to sort out.  I couldn't say things any better than Amanda and Jo.  Unfortunately you will have to wait to get specific advice from your rheumatologist, as to what the test results mean in your particular circumstances.

 

Personally, I'd always be more prone to focus just on what your current symptoms are. After all, you can only treat symptoms that you have, not any that you don't have or might possibly get in the future, right?  So for today, just focus on tending to your existing issues, which should keep you plenty busy right there until you see the rheumatologist. 

 

Also remember to go to your primary care doctor for any new or worsening symptoms. Some people get it stuck in their head that they have to "save" their symptoms up until they see the specialist, and nothing could be further from the way the system should work. Your healthcare should never be delayed over it, and your primary care doctor should be able to assess all your symptoms and begin usual treatment for them (such as perhaps ordering anti-inflammatories and physical therapy for joint pain, etc.) and getting them sorted out ahead of time can make your rheumatology appointment even more productive.

 

Please keep in touch with how things go for you. Regardless what the doctors decide now or later in regard to scleroderma, we are always here for you.

 

:emoticons-group-hug:


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#5 Kathy D

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Posted 07 October 2014 - 10:09 AM

Kermodi,

 

Joint pain is what finally got me into a doctor!   Once there I asked him about my other ailments, too long to list here.  I had dealt with so many for so long it didn't occur to me to say something sooner :sickly:

 

Incidently I am rheumatoid factor negative but anti ccp positive.....  If you have an elevated ANA they will try to find if you simply just test positive for it, or if it the cause for your symptoms, I have gladly heard many stories with +ANA but they did not have an autoimmune disease.  For instance, some rheumatic diseases can test positive for syphyllis though most dont have it.   Whether or not some tests are positive or negative, I think alot of meds treat autoimmune as a whole, not just for one particular rheumatic disease.  For instance I take drug commenly prescribed for lupus patients as well as prednisone that is tried and true for RA though my main problem is sclero :blink:  .  Whatever works, your rheumy will help you figure it out!

 

Nuclear Ab/ANA:  5.0 (High) 
(Moderate Positive 2.0-5.9)

I think the term "nucleolar" is an ana pattern, could you have misspelled?  Or it might just be a different way of identifying the test at that lab?

 

I have no idea but if it were me I would guess there was an error on your anti ccp test and thats why they did not list the value.  Call and leave a message for your doc about it.

 

Sorry you have to wait, many of us have the same hard weeks to get into a rheumy, not fun, but you will make it  :VeryHappy:


Diffuse Scleroderma Diagnosed March 2009

#6 Amanda Thorpe

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Posted 08 October 2014 - 04:02 AM

Hello Kathy

 

You make a very relevant point, they feed all dogs dog food. Say what? Some doctors see no advantage in labelling with scleroderma because the same medications are used to treat all connective tissue diseases such as MCTD, UCTD and scleroderma.

 

Take care.


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