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Does my blood work, CRP show AUTOIMMUNE DISEASE?

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Here are the results of recent blood work:
Neutrophil %: 81
lymphocyte %: 13
abs lymphocyte: .6

also C Reactive Protein Inflammatory: 29.2

I have arthritis (always test negative for RA) but I am worried that I really have some other autoimmune disease. My doctor is not concerned about these recent test results and I wonder if that is correct.

Thank you,
Mary Vargas

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
 24 Doctors Online

Hello. Thank you for posting your query at our health forum.
I understand your concern.
I will advise you to upload all your test results, so that it gets easier for us to interpret. Based on what you sent, your neutrophils are slightly higher, can indicate some ongoing bacterial infection. If you're asymptomatic then it can be overlooked.
Your CRP values are definitely on the higher side, and the possible reason is Rheumatoid Arthritis, IBD, connective tissue disorders, e.t.c However since you're negative for Rheumatoid Arthritis as you mentioned, i am assuming your RA factor is negative? I need some additional history from you to be able to help you. I need to know about the symptoms you had before you were diagnosed, if you are on any medication, any current joint stiffness? Please give an elaboative history. Does anyone else in your family have any history of auto-immune conditions?
I will assist you further, once i get all the details.

Patient replied :

Yes, several siblings have thyroid problems, my mother had Grave's disease, and one sister has Rheumatoid Arthritis. I have been tested several times for RA factor and it is always negative. In the past five years I have had two positive ANA tests but no further indications. I am really worried about the low lymphocytes.
I have joint pain, fatigue, stomach pain, dry eyes, weight gain, headaches, osteopenia, entire body tremors (I shake uncontrollably, but certainly not everyday) uncontrollable itching, and I had to stop taking Mobic because apparently it gave me an ulcer (Negative h.pylori) so it must have been from the NSAID. I have headaches at least twice a month and although I even had a brain scan no one can tell me why I get headaches. It takes me longer to get over an illness and I thought it was because I am getting old (55) but maybe something else is wrong. Could a case of costochondritis actually have been something else?
I have uploaded my recent test results. The doctor says she does not need to see me again unless I want to come in. I don't want medicine I just want to know why I feel like crap all the time. Should I be worried about the low lymphocytes???
I am so sorry for all the questions. I am at my wit's end, I feel like a hypochondriac and I hate to bother people but I really want to know what is wrong with me.
Thank you

Hello Ms. Vargas. Please do not be sorry. I understand what you are going through and we're here to help.
You have mentioned having two positive ANA tests. Was a detailed ANA profile done where a variety of antibody levels are estimated? A true positive ANA result indicates an autoimmune disease. Your symptoms of joint pains, fatigue, dry eyes etc could all be due to an autoimmune disease like Sjogren's. This can be confirmed by estimation of Anti-Ro and Anti-La antibodies as well as tests to determine dry eyes etc. Please see if you can upload your ANA test results. Sometimes, Sjogren's is associated with Rheumatoid Arthritis. Absence of Rheumatoid Factor does not rule out RA. A more specific Anti-CCP antibody test has to be done. If this too is negative, then RA is unlikely.
Osteopenia could be due to a post-menopausal Calcium deficiency. Please make sure that you take Calcium and Vitamin D supplements regularly.
Your headaches could be due to migraine which is the most common cause of headaches in the general population. This is a benign (harmless) with no structural abnormality in the brain and hence the brain scan will be normal. Analgesics (painkillers) is the first line of treatment and if your headache responds to this, nothing else is needed.
The tremors seem to be a non-specific complaint. If you have symptoms like profuse sweating, weakness and dizziness along with the tremors, it could be due to hypoglycemia, due to Diabetes. In that case, you need to get your sugars tested. If there are no other symptoms, tremors could be due to anxiety.
Now let me answer your specific questions. Costochondritis when diagnosed after evaluation by a doctor, could be costochondritis itself. Its unlikely to be anything else.
You do not have to worry about the low lymphocytes because your total WBC count is normal. The decreased lymphocytes is only a relative value, termed relative lymphocytopenia, and it is low because of an increase in neutrophils, which could be due to some infection your body is fighting off in the background. These cell counts are dynamic and keep fluctuating in individuals with a normal immune system. So it should not be a cause of concern.
In summary: -I would suggest that you consult a Rheumatologist for a detailed workup. You would need an Anti-CCP test as well as a detailed ANA Antibody profile test, if these have not already been done. -For the pain, you can take selective NSAIDs like Celecoxib, in consult with your doctor. It does not cause ulcers unlike non-selective NSAIDs. This can be combined with a PPI like Omeprazole or Pantoprazole for added protection against ulcers. -Diet control and exercise should work for the weight gain. -Please take Calcium and Vitamin D supplements everyday to correct Osteopenia.
I hope this was helpful. Feel free to ask queries. Thank you.

Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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