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srss 02-01-2014 04:26 PM

8 yr female??? What should I expect?
Hello, My daughter started having regular joint pain not in the same spots. Back, shoulders, elbow, fingers, toes, ankle and knees. She is also moody, irritable and emotional. Went to the peds and she had a positive ANA with a titre of 640. We were refereed to the peds rheumy who about 30 other tests that apparently cam back normal/negative and was told to follow up in 3-4 months. I am confused, what does this mean? Does this mean there is no blood or organ disease present? I am thinking a second opinion is necessary, I am worried sick and would appreciate some advice or suggestions.

VeeJ 02-03-2014 03:45 AM

Re: 8 yr female???What should I expect
Hi & welcome. I'm sorry your 8-year old daughter is struggling. That has to be very hard on her & you, too. Anyhow, I'd want to know WHICH tests were run by the pediatric rheum, also verify the results. You could ask for a copy of all labs (incl. urinalysis), then post again on what you see, incl. your questions.

My best guess is that the ped rheum is considering Juvenile idiopathic Arthritis (JIA) as one possible candidate. JIA is an umbrella term for a fairly common form of sudden-onset arthritis affecting chidren younger than 15 years of age. The problem is that there aren't "specific" tests, so drs. look for certain common markers, such as low RBC, high WBC, high ESR, high CRP, etc. in addition to joint pain with or without swelling. Also for spiking fevers as high as 103, striking 1-2 times daily at the same time of day. Also rashes (salmon-colored or sometimes resembling psoriasis, on trunk and extremities). The "rub" is this: to be given a diagnosis of JIA, the pain must have lasted AT LEAST 6 WEEKS, which could explain why you were told to return in 3-4 months.

But I'd guess that she ran tests for other autoimmunes, too, like lupus. Again, if you were to get copies of the labs & list the test names you see, I think people here could tell you which are ones are commonly run for lupus and its "close cousins".

Re: organ involvement, certain tests in the CBC and Metabolic Panel, plus urinalysis, should flag problems with certain major organs like liver & kidneys, etc. When you get copies of the labs, if those panels all look good, that would give you at least some reassurance.

I had a huge hit at 13 that could have been handled better, but that was decades before the internet gave us the ability to solicit thoughts from other patients & parents.

So, anyhow, that's what I'd do: first get copies, to mull & discuss what's been done so far---and then you could better decide whether to book a second opinion. I hope others add their own thoughts to this. Thinking of you both & sending best wishes, Vee

P.S. Did the ped rheum suggest anything to take for the pain, like OTC NSAID's?

ladybud 02-03-2014 09:07 AM

Re: 8 yr female???What should I expect
Ditto to what Vee suggested. It would be helpful to see what was tested and especially any abnormal or borderline results. Some Ibuprofen would probably help her joint pains.

srss 02-03-2014 12:27 PM

Re: 8 yr female???What should I expect
Test results as follows: Peds office- postive ANA with a titre of 1:640 speckled

Peds Rheumatology- all normal levels or negative
Sed rate 9
WBC 6.4
RBC 4.94
Hemo 13.0
Hematocrit 38.4
MCV 78
MCH 26.3
Platelet 290
Neutrophils 58.4 was 66
Lymphocytes 30.9 was 28
Monocytes 8.5 was 5
Eosinophilis 0.1 was 0

reactive lymphocytes are present

C3 103
C4 19
Smith antibody IgG 3
Rib protein IgG antibody 0
Sclerderma 0
CK total 56

IGG 957
IGM 107

I have another page of results but what would be pertinent in me posting? I appreciate the advice.

ladybud 02-03-2014 01:19 PM

Re: 8 yr female???What should I expect
I may have some good news about your daughter's results that were posted. Her blood count shows reactive lymphocytes. These are usually seen in mononucleosis caused by Epstein Barr virus or cytomegalovirus and sometimes hepatitis. If her liver enzymes (AST, ALT) are normal, that rules out hepatitis. Has she had tests done for mono? There is a mono spot test, and specific EBV and CMV titers can be done too. These viral infections can last 2-3 months, occasionally more, and can trigger other antibodies, like ANA, to develop. This may be a self-limited viral infection, and I hope for her sake it is. I would certainly ask for mono testing to be done, as her symptoms could fit with that.

srss 02-03-2014 07:16 PM

Re: 8 yr female???What should I expect
I guess I am not sure if there specifically was mono testing done. However obese told she did not test positive for strep.

ladybud 02-03-2014 07:50 PM

Re: 8 yr female???What should I expect
You might look over her other labs that you didn't post to see if a "mono spot" was done, or EBV or CMV titers. If not, I would ask for that, as with reactive lymphocytes on blood count, that would be my primary suspicion. That is much less worrisome than some of the more serious conditions that might be considered. 85% of people in US get the mono virus during their childhood, adolescence or adulthood. It typically causes cold symptoms, fever, sore throat, swollen glands and often significant aching and joint pains. It lasts several weeks, and makes one feel very tired and sluggish, sleepy. It usually clears up completely and the virus remains dormant (inactive) after the illness.

srss 02-03-2014 09:15 PM

Re: 8 yr female??? What should I expect?
Those tests I am not seeing, I however do see a negative anti streptolysin.

She has had ongoing all over joint pain, fingers, hips, ankle, back, knee. No fever, not overly tired, moody, irritable, sensitive, stomach aches, noticeable hives that come and go.

I will request that test. Any other suggestions or possibilities? Why would she have these symptoms and a positive ana, could it be false? Will it go away? Do I wait the 3 months or request a second opinion? TIA

ladybud 02-04-2014 07:18 AM

Re: 8 yr female??? What should I expect?
How long have her symptoms been going on? Do you remember any signs of infection at the beginning? It is good an anti-streptolysin was done. That rules out rheumatic fever. If her symptoms started within the last 2-3 months, I would be at least a little hopeful this is mono related. If much longer than that, I would be more concerned about lupus or another autoimmune disorder similar. Were thyroid antibodies checked? That would appear as anti-TPO and anti-TG on the lab sheets. Autoimmune thyroiditis can cause a + ANA, hives, and joint pains too. What is the family history in terms of autoimmune disorders? Is there any? There is also a possible connection between EBV (mono) triggering lupus in susceptible people. So there are still a couple of possibilities to rule out, IMO. I would ask for mono spot and if neg run EBV titers, and the thyroid antibodies if not already done, before thinking of a second opinion.

srss 02-04-2014 08:08 AM

Re: 8 yr female??? What should I expect?
These specific symptoms have been happening for 2 months.

There was no current mono spot testing, however when I called to ask about this they did tell me she had a positive mono spot in 2012, I had no idea. She was never treated for this so I am completely confused. I am waiting for a call back from the peds office to discuss this in more depth.

Could this mean she has mono or why would you have previous positive results?

Thank you so much for the advice.

srss 02-04-2014 01:10 PM

Re: 8 yr female??? What should I expect?
No specific family history. Also thyroid antibodies negative.

srss 02-04-2014 06:30 PM

Re: 8 yr female??? What should I expect?
Correct and correct- no diagnosis of any family history known. I am going for a second opinion, however it may be a wait.
LD 516
Aldolase 6.2
Bilirubin conjugated 0.0
Bilirubin delta 0.2
Bil Total 0.3
Albumin 4.7
Protein total 8.0
Creatine .50
Glucose urine negative
bilirubin urine negative
ketones negative gravity urine 1.014
TSH 2.52
Mucous Present
Thyroid Peroxidase antibody <10
DNA-ds negative <15

ladybud 02-05-2014 08:11 AM

Re: 8 yr female??? What should I expect?
The LD I assume is LDH, and it is fairly elevated. It is always helpful to include the reference ranges with lab results, as reference ranges vary between labs. That would indicate some liver involvement at the time it was drawn, which would certainly fit with more with mono than lupus. Transient hepatitis (inflammation of liver) frequently occurs in mono and subsides within about 2 months + or -. If her mono spot was positive in Nov-Dec 2013, I would bet this is mono and she should recover. Specific EBV/CMV titers could be done if this lasts beyond 3-4 months symptomatically. That would also help to determine if she is having recurrent viral activity episodes, since her mono spot was also positive in 2012. If she had spleen enlargement during this episode, I think that would also favor mono. Could you also check to see if AST/ALT were done on blood, also liver enzymes?

srss 02-05-2014 08:38 AM

Re: 8 yr female??? What should I expect?
I am seeing LD not LDH 516 325-750 u/l
ALT 33 0-55
AST 38 0-55
I am not recognizing anything that says liver enzymes however it maybe called something else
Her mono spot was done in Jan 2012 and June 2012 both positive but never tested again

srss 02-05-2014 12:21 PM

Re: 8 yr female??? What should I expect?
Is there a way I can scan and post or send the all of the lab work???

I spoke to peds doc and she said to get a second opinion, she doesnt think the mono spot test is relevant but she did say she is not a specialist.

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