What Causes High RA Factor When Diagnosed With Lupus?

Posted on Thu, 7 Jul 2016

Question: HI. I am a 65 year old male. I have an extremely high RA factor (200-250) and have for almost 2 years but neither my primary care physicial nor rheumatologist can see any physical presentation or Xray evidence for rheumatoid arthritis. I just got test results back for Lupus (ANA/anti-DNA) and both are normal/negative. I have had numerous blood tests for metabolic panels and everything is within normal ranges. My cholesterol levels are normal. My A1c is 5.6. Liver and kidney tests are all normal. I do take levothyroxine for minor hypothyroidism. I am concerned the high RA factor indicates some immune disorder that could be indicative of something serious but given the lack of confirming test results and the lack of physical presentation, my primary care physician is of the impression that it's a genetic aberration, a benign marker of sorts, that has no relative importance regarding my health, morbidity, etc. What say you?

Answered by Dr. Dr. Shruti Rijhwani (53 minutes later)

Brief Answer:
Have you been evaluated for Sjögren's syndrome ?

Detailed Answer:
Dear Sir,

Thank you for posting your query on HCM.

Well looking into your problem I would like to tell you that , your rheumatoid factor is positive in high titres . Yes there is a possibility that you may this positivity but you don't develop rheumatoid arthritis , this does happen in few cases . Till we don't see swelling over joints convincingly arthritis is not diagnosed even if markers remain positive . But in Sjögren's syndrome also patients have high rheumatoid factor . Do you have any dryness of eyes or mouth or feel swelling on the angle of jaws ? I think you need to discuss this possibility with your treating doctor as many times this is missed and it's very common to have this disorder when r,hematoma factor titres are high . Also I would like to know whether your Anti CCP antibody levels , ENA profile has been done or not . Any other query please ask .

Take care.

Dr. Shruti

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Shruti Rijhwani (27 minutes later)

To answer your questions:

I have no dryness in eyes, nose, or mouth. No swelling in jaw.

My Anti CCP levels are also high (> 250) which I understand to confirm RA but again no physical presentation or Xray indications.

Sjogren's AB is <0.2; RNP and XXXXXXX antibodies both <0.2

I have 6 pages of blood test results but see nothing specifically listed as ENA profile. (Lupus, CBC, Comp Metabolic panel (14), Urinalysis, G-6-PD, Anticardiolipin, Antiextratable Nuclear AG, etc., etc.) Is there a specific test within the ENA profile I might be able to give you?

All test results are within normal ranges with the exception of RA and CCP, which to my untrained eye appear to be extremely high.

Once again, my primary concern is not RA, rather indications of some more serious immune disorder - lymphoma, vasculitis, hemocratic anemia, etc.

I do not have HIV, Hep C, or Lupus.

Thank you.

Answered by Dr. Dr. Shruti Rijhwani (12 minutes later)

Brief Answer:
Follows.

Detailed Answer:
Dear Sir,

Thank you for reverting back .

Your ENA has been done , anti extract able nuclear antigen stands for that only . So if Sjogrens is ruled out then if lymphoma ethic are very rare . If there is no enlarged lymph nodes then looking for lymphoma etc . is very unlikely situation . I think that you should just relax and be in touch and regular follow up with your treating doctor because by the amount of tests they have done and the way they have evaluated you , they have done it fully and competently .So am sure they will able to care of you fully , at present only careful follow up is required and nothing else to be done .

Dr. Shruti

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. Chakravarthy Mazumdar