Conflicting Information and Rheumaoid Factor

[Deb9991]

On another post, the web site "http://www.theboltons.plus.com/index.html" was suggested as a good source for information.  I did find it educational, especially for people new at the Hep C game.  The author of this site did say a few things that made me stop and think.  He said that drinking too much water can be detrimental to achieving SVR.  His reasoning is that while treating, you absolutely do not want to flush the medications out of your body -- you want them to hang around and do the necessary work they were called to do.  Actually, that does make sense to me intellectually and I've also heard scientists say that because of the human body's remarkable regulating system, it tells us when we are thirsty and when we are hungry, etc., and we take steps to abide by our bodies' demands.  He also said to take riba with fatty foods, because of "absortion" issues.  Does anyone have any comments to make regarding these issues.  I'd like to hear from you and get your opinions.

Also, on my rheumatoid factor lab tests, I received a number of 14.  What does that mean?  

I greatly appreciate any information or insights into these issues.

Thanks,
Debbie

[Deb9991]

Heehee -- Burt probably did, but I don't have any personal knowledge of that, darn!  I'm looped.  

If you live long enough, and keep your old clothes, eventually they'll come back in style.  What hurts is when you realize you've worn those old jeans three different times in your life!  

Just enjoy your youth while you have it -- because in four years it will be gone.  

d

[spectda]

Hi deb,

I think Burt had "big hands"

By the way, are you saying that bell bottoms are out of style, I think they call them something else now! Is the patchwork thing outdated also?

You old people make a 52 year old feel like a kid! LOL

[Deb9991]

Between you and Bill, I've learned so much it is incredible.  

Heehee -- I'd love to see that picture of Bill!  Bill and I are the same age, and you are a few years younger, but I'm sure you remember the bell bottoms that dragged the ground, and the Burt Reynolds mustaches!  Oh, those were the days.  I'll never forget when Reynolds posed nude (everything important was covered up) in Playgirl in 1972 -- women went crazy -- I was a senior in high school.  There were stampedes to get that magazine!!!  Oh, in his day, whatever it was, he had it!!!!!

Later, Deb

[spectda]

I've had some hispanic friends who called me dabey! What ever makes you happy Deb! If you can give me some UND magic you can call me anything!

The internet just has so much information available for us if we want to look. I don't like being uninformed about my condition, and I know doctors make mistakes. we can only advocate for ourselves if we have some information and knowledge to back it up. Many of us gain more knowledge in about own particular afflictions.

Our own bill is like medical encyclopedia, There seem to be few things he hasn't heard before. I hear he is going to be starting a dear bill thread, I think he was distantly related to abbey! Rumor has it that someone found a pic of him with really long hair, a burt reynolds mustache, a nerhu shirt and medallion and some bell bottoms. I hope he posts the pic on his dear bill thread.

[Deb9991]

Dave, I typed "Davie" and then backspaced and typed Dave -- but, I can actually see that I could get away with calling you Davie.  To be on the safe side though, I'll stick with Dave.

You have given me a wealth of information that I have copied and filed in Word.  I have all my lab reports, and a lot of studying to do.  Your knowledge is formidable and impressive.  Are you sure you are not an M.D. and haven't told any one?  

I have learned more -- far more -- from this forum than from any medical provider that I have had over the years.  It is great -- not to mention a free education to boot!  

It is also comforting to have the emotional support from this forum too.  I have no idea how I will feel a month from now, or three months from now, but however I feel, I know I can come here, and get my questions answered.  It is just great.

Thanks,
Debbie

[spectda]

Can rheumatoid factor be present in a patient without rheumatoid arthritis?

Yes. Rheumatoid factor is also present in patients with other conditions, including other connective tissue diseases (such as systemic lupus erythematosus), some infectious diseases (such as infectious hepatitis, syphilis, infectious mononucleosis, parasites, and tuberculosis), liver disease, and sarcoidosis. Rheumatoid factor can also sometimes be present in normal individuals without diseases. This occurs more frequently in people with family members who have rheumatoid arthritis.


What significance does the rheumatoid factor hold for patients with rheumatoid arthritis?

High levels of rheumatoid factor are associated with more severe rheumatoid disease. This factor is also associated with a higher tendency to develop non-joint manifestations of rheumatoid disease, such as rheumatoid nodules and rheumatoid lung disease.

[spectda]

I think I sent this to you before; this explains the difference between real RA and the type that Mimics it.

http://www.hcvadvocate.org/hcsp/articles/Bonkovsky-2.html

RHEUMATOLOGIC and AUTOIMMUNE MANIFESTATIONS OF HCV
Myalgia (muscle pains), fatigue and arthralgias (joint pains) are common manifestations of HCV infection. HCV-related arthritis commonly presents as symmetrical inflammatory arthritis involving small joints. The joints involved in HCV-related arthritis are similar to rheumatoid arthritis (RA). This sometimes makes it difficult to differentiate true RA from HCV patients with positive rheumatoid factor but without RA. HCV-related arthritis is usually non-deforming and there are no bony erosions in the joints. A marker called anti-keratin antibodies has been studied to differentiate true RA from HCV related arthritis. In a recent study, 71 patients who were rheumatoid factor positive were tested for anti-keratin antibodies. Anti-keratin antibodies were detected in 20/33 (60.6%) patients with true RA and only 2/25 (8%) patients with HCV-related arthritis (10). Patients with HCV-related arthritis seldom respond to anti-inflammatory medications, and although there are no controlled trials to address this issue, it has been recommended to treat these patients with combination antiviral therapy of interferon and ribavirin (11).

Sjogren’s syndrome (SS), an autoimmune disease characterized by dry eyes and dry mouth has been found in some studies to be more common in HCV infected patients. They differ from primary SS in that they do not have lung and kidney involvment. Thus it is recommended to test for HCV infection in patients with SS or primary SS. A study by El-Serag of 34,000 veterans failed to show a significant association between HCV infection and diabetes, SS, or autoimmune thyroid disease (9).

Interferon therapy of HCV infection may also trigger the development of autoimmune diseases, the most frequent of which is autoimmune thyroiditis (Hashimoto’s thyroiditis). This may lead transiently to hyperthyroidism, but eventually to hypothyroidism (underactive thyroid) and to the need for life-long thyroid replacement therapy (Bonkovsky & Mehta).

[spectda]

Hi Deb-
There is a test for RF (rhuematoid factor) and a test for RA (rheumatoid Arthritis) Because you are positive does not mean that you have rheumatoid arthritis. Many people with HCV will have RA levels in their blood, but they are sometimes not real ra, but something in your blood work that mimics ra. further testing needs to be done to be sure if it is actually ra.

under 20 for RF is considered in range, mine was 45 and is considered low.

http://www.orthop.washington.edu/uw/livingwith/tabID__3376/ItemID__95/PageID__122/qview__true/Articles/Default.aspx#4354

"Immunological blood tests

What is the immune system?

To help you understand why immunological blood tests are performed, following is an explanation of the immune system.

The immune system is the body's natural defense against foreign invaders, such as bacteria or viruses. Occasionally, the immune system breaks down and loses the ability to distinguish between its own body cells and foreign invaders. In autoimmune diseases, the immune system fights its own body cells as if they were invaders. When an invader such as a virus enters the body, the virus creates what is called an antigen. The body's immune system fights the antigen by creating an antibody. When the immune system fights against its own body cells, it creates autoantibodies that attack the body itself. Antinuclear antibodies are autoantibodies that react against the nuclei (cores) of the body's own cells when these cell parts are mistaken for foreign invaders.

What are autoimmune diseases?

Several types of rheumatic diseases are known as autoimmune diseases. These diseases can be traced to a defect in the body's immune system. Depending on the defect, inflammation may occur in the joints, muscles, internal organs, skin, blood vessels, eyes, or mucous membranes. If your doctor suspects you might have an autoimmune disease, then immunological tests usually are ordered. Such tests include rheumatoid factor, antinuclear antibody, complement, and human leukocyte antigen (HLA) tissue typing.
What is a rheumatoid factor (RF, Latex) blood test? What is a normal range for rheumatoid factor test results?

This measures whether a certain amount of abnormal antibody called rheumatoid factor is in the blood. The majority of people with rheumatoid arthritis (a common disease of inflamed joints that can cause joint alignment problems and loss of function) have a large amount of rheumatoid factor in their blood. However, up to 20 percent of adults with rheumatoid arthritis may never have any rheumatoid factor in their blood. In contrast, about 85 percent of children with juvenile rheumatoid arthritis (ERA) are negative for rheumatoid factor (ERA is a group of diseases, similar to rheumatoid arthritis, that begin in childhood). It is important to note that having a positive rheumatoid factor will assist in the diagnosis, but the test alone is not conclusive.

Methodologies

Latex agglutination testing is still widely used although it is being supplanted by other methods including ELISA and nephelometry that are capable of being done by machine rather than by hand to hopefully improve standardization and reproducibility. Nephelometry uses laser light scatter to measure the formation of immune complexes in this case, rheumatoid factor and human IgG.

Normal range

The latex test is reported in a titer with most labs considering > 1:40 as positive. The nephelometry test is usually reported in international units and the normal range is dependent on the specific laboratory usually < 20 IU.

Utility

Rheumatoid factor is not sensitive nor specific enough to rule in or out rheumatoid arthritis. The rheumatoid factor is present in 70-80% of patients who have RA. This means that 20-30% of patients with RA are seronegative for rheumatoid factor. It is most useful as a prognostic indicator in patients with RA. People with RA who are rheumatoid factor positive typically have a more aggressive disease. It is also useful in confirming one's clinical impression that a polyarthritis that looks like RA is even more likely to be RA. It is also followed in patients with Sjogren's disease to predict the development of lymphoma. Rheumatoid factor production may be a way for the immune system to enlarge immune complexes to make them more easily removed by the spleen and other immune organs.

What are antinuclear antibody tests (ANA)?

These detect a group of autoantibodies that are found in most people with lupus and scleroderma and in a few people with rheumatoid arthritis. These autoantibodies react with antigens in the nuclei of cells. The antibodies suggest that an autoimmune illness may be present, although many people test positive and have little evidence of serious disease. Specific antinuclear antibody tests are helpful in the diagnosis of certain rheumatic diseases that involve abnormalities in the immune system. The names of the following tests are abbreviations of more complicated-sounding tests. The diseases for which they are used include:

systemic lupus erythematosus (multiple-system illness, may involve the skin, joints, kidney, etc.); anti-dsDNA, anti-Sm, anti-Ro/SS-A, and antihistone tests help confirm the diagnosis.
scleroderma (a marked thickening of the skin); the anti-Scl-70 test helps confirm the diagnosis.
polymyositis (inflammation of muscles, resulting in muscle weakness, sometimes with joint inflammation); anti-Jo-l and anti-PM-l tests may help confirm the diagnosis.
Sjogren's syndrome (disorder marked by dry eyes and dry mouth); anti-Ro/SS-A and anti-La/SS-B tests may help confirm the diagnosis.
mixed connective tissue disease (a syndrome with a variety of symptoms, including joint inflammation and swollen fingers); the anti-Ul RNP test helps confirm the diagnosis.
What are complement tests?

These tests measure the amount of complement proteins circulating in the blood. Complement tests involve the reaction of antibodies with antigens. These tests usually are reserved for diagnosing or monitoring people with active lupus. Those people with lupus frequently have lower-than-normal amounts of complement, especially if the kidneys are affected.
What are human leukocyte antigen (HLA) tissue typing tests?

These tests detect the presence of certain "genetic markers" or traits in the blood. For example, B-27 is a genetic marker that nearly always is present in people with ankylosing spondylitis (a disease involving inflammation of the spine and sacroiliac joint) and Reiter's syndrome (a disease involving inflammation of the urethra, eyes, and joints). This test also is positive in five to 10 percent of the healthy population."

[Deb9991]

CoWriter:

I appreciate your taking the time to answer and respond to my post and thank you for providing me this information.  

I think that old adage "go with the majority," when in doubt is the best approach, because with anything, there are people who have differing views.  The problems with the Bolton web site, or as much as I read, were the lack of quotes and scientific references. That made me nervous.  

Heeheee -- that was funny about the Mars Bar, but kind of scary too when you really think about it and some naive person taking it to heart!

Debbie

[CoWriter]

"Also, on my rheumatoid factor lab tests, I received a number of 14.  What does that mean?"  
---------------

That's considered normal.

Co

[CoWriter]

By the way, Mr Bolton failed treatment.  Perhaps he ate fat, Mars Bars and didn't drink water.

Co

[CoWriter]

You must always consider the source.  Mr Bolton also recommends eating a Mars Bar to treat low blood sugar, which can be a sign of insulin resistance.  He also says that insulin resistance in HepC patients doesn't exist.

When I challenged what he was saying, he banned me.  I disagree with his water, theory, his fat and riba theory and his "Mars Bar Theory" and I am proud to be a "Bolton Wanderer".  That's what those of us who got banned in his forum for challenging his outrageous statements are called.

I feel very sorry for any newbies who happen to land on his forum by chance.

Co