Decreasing Levels of IgM-RF and Anti-CCP with RA Treatment

From All Joints Considered, rheumatologists are starting to acknowlege that what patients have been saying might be true.  This is SO exciting! 

This may sound familiar to young Rheumatologists and will give seasoned Rheumatologists a feeling of “I told you so”. Here is the scenario: You are seeing a patient with RA, who was previously followed by a retired partner. The patient was diagnosed with RA in the 80’s or early 90’s and you can’t find a RF to speak of. By looking at the patient, you do not see any chronic deformities from RA. The patient has taken the same DMARD for several years. So, you question the diagnosis (as you have been trained to do). You order a RF and anti-CCP and they come back negative. Next, you suggest tapering and discontinuation of the DMARD and next thing you know they come back with horrendous synovitis.

Click here to read the remainder of the article (requires MedScape login).

The AF board occasionally has stories of people who dread moving because a new rheumatologist will run new labs, then discontinue DMARDs — with very very bad results.

My current rheumy repeated all the blood tests that my first rheumatologist ordered (plus a boatload of others).  How can CCP go from 175 to 4?  Rheumy says that doesn’t happen; the first lab must have been wrong.  Fortunately for me, she’s treating me based on symptoms, not based on lab values.  I’m sorta curious what would happen if I stopped all meds (but not so curious that I’m willing to be the guinea pig and actually try it).

It is exciting to see advances made in the understanding of RA.  Sure, a cure would be nice, but I’ll take whatever progress we can get.


3 thoughts on “Decreasing Levels of IgM-RF and Anti-CCP with RA Treatment

  1. This is really interesting.

    I’ve never been tested for rheumatoid factor and the host of other things most RA patients are immediately tested for now. When I was diagnosed, nobody really did those tests and I’ve always been treated based on symptoms (including sky-high sed rates). When I did stop my Enbrel after losing coverage, my symptoms returned full force. We know it’s real, and I feel really fortunate that my rheumatologist treats me based on my symptoms. Sounds like you have a great doc, too.

  2. Here’s a blurb I just read last nite:
    Levels of anti-citrullinated protein antibodies and IgM rheumatoid factor are not associated with outcome in early arthritis patients: a cohort study

    I’ve never had the AC levels run, and only had SED rate done three times I believe and it’s gone up and down, but current rheumy doesn’t believe in running it all the time. I’ve been positive RF since 96 at least but did not get an RA diagnosis until the end of 98.

  3. When I was first diagnosed, the RF factor didn’t show up in my blood test. I don’t recall him ever mentioning sed rates, but this was back in the mid-80s. Based on my symptoms, however, he made a clinical diagnosis. Over the years, as I had blood test after blood test, the RF factor did show up, but only now and then. I thought this odd; Dr. C did not. He told me that it’s not the difinitive sign of RA, but only one of them. Thinking back about it, I was lucky to have him as my doctor, as there were no rheumatologists available closer than a four-hour drive away.

    When I finally did go back to a doc for RA, after a long remission in symptoms, it was to a rheumatologist and roughly 18 years had passed since that first diagnosis. Now the RF factor is always in my blood, and while the sed rate varies, it’s always much higher than normal, owing to constant inflammation in my body. And that’s in spite of medications.

    Seems that Dr. C, who was a young Army doctor, was a lot smarter than I ever gave him credit for (though I did like him). Thanks, Dr. C, wherever you are!

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