As humans, we want definitive answers. It's what we all look for in everything we do.
When it comes to our health, it's even more important. We want to be sure when someone says something is wrong, and we want to be sure when someone tells us how to fix it.
In many areas of medicine, we have sophisticated amazing tests which are accurate, sensitive and specific. They can tell us exactly what is going on and sometimes, can even tell us what the best treatment option is. Heart disease is a great example of this. There are blood tests which can tell you if you are having a heart attack, with further tests which can not only help confirm it, but treat it too. The same can be said about kidney disease, diabetes, and many more medical conditions.
When it comes to arthritis and rheumatic diseases, it gets a little more tricky. As of the time of this article, we have very few tests which tell us the whole story when it comes to rheumatic disease. As examples:
Osteoarthritis - often thought of as wear and tear arthritis, it doesn't have a great test. Certainly there is no blood test for it. X-rays can see it, but x-rays don't always agree with the degree of pain and functional impairment it's causing. It only tells a small part of the story and does not tell us the best way to treat.
Rheumatoid arthritis - There are a number of blood tests which can be associated with RA, but none of them are perfect. Elevated inflammatory markers can be seen (CRP, ESR), but an infection can also cause them to be up. Conversely, many RA patients will have very active disease with normal markers. A rheumatoid factor test and a newer CCP test are also associated with a diagnose of RA, but neither are perfect. You can test negative and have terrible RA, or test positive and never get RA. X-rays can be helpful but if we are seeing x-rays changes from RA at the time of diagnosis, we have missed the boat, so to speak.
Lupus - Many folks associate a positive ANA test with lupus. While a negative test does more or less rule out lupus, a positive test does not diagnose lupus. In fact, perhaps only 1 of 200 positive ANA tests are associated with lupus!
In rheumatology, blood tests help tell the story, but they are not the story themselves. You are.
The most critical piece to finding out what might be happening in rheumatology is telling your story to your rheumatologist or health care provider. There are common patterns we see in most rheumatic disease that rheumatologists are experts at identifying. Rheumatologists can piece together your story, your physical exam finding and your lab results to determine what may or may not be happening.
Sometimes that may feel disconcerting, but remember, no one knows you like you. So trust yourself. Share your story. Work with your health team and by working together, answers can be found.