RA Diagnosis Uses Lab Tests, Clinical Insight to Rule Out Lyme

What acts as an accelerant to periodontal disease? Smoking. In fact, the combination of heavy cigarette use, periodontal disease and positive HLA-DR4 status raises the relative risk of developing RA by as much as 20 times as compared with the general population.⁵ What’s more, the recognition of RA in the Old World followed the importation and heavy use of tobacco from the New World, a form of Cosmic Payback for the catastrophic decline of Native Indian tribes from the European introduction of smallpox.

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But if so, what of Lynn P.? How did she fit into this working hypothesis? As a lifelong nonsmoker with pristine teeth and gums, why had she developed RA? The oral bacterial trigger hypothesis would seem to be incomplete.

Crohn’s disease is an immune system disorder affecting the bowel and can be accompanied by inflammatory arthritis.
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When Lynn returned, I noticed that she’d canceled her two-week follow-up and rescheduled, now three months later. The baby wasn’t with her, but her shaggy-haired husband, John, was. He rested an elbow on the arm rest and extended one finger along his cheek, another between his lips, giving him a thoughtful, relaxed appearance. I sat on a swivel stool half facing a narrow wall-mounted desk where I could take notes.

I could see that Lynn had a list of questions on her lap. It took her two attempts to unfold the yellow-lined papers. When the pen slipped from her hand, she awkwardly bent and tried to retrieve it before her husband, without a word, reached down and placed it back in her hand.

“Well, I hope you have some answers for me.” She casually flipped a stray band of hair away from her face and winced with the effort.

“I do. Here, let me review the lab with you and your husband.” Hearing this, John leaned forward. “The sedimentation rate and this other test, the C-reactive protein, are elevated. You might remember that early on, when your doctor tested them, they were in the normal range. They don’t tell us specifically the cause of your inflammation, but they give us a good sense of severity. And here, the parvovirus test. It’s negative.” I handed the papers to Lynn, who in turn passed them on to her husband.

Numerous studies have shown the risk of developing various disorders (e.g., heart disease, colon cancer, hypertension, diabetes, to name but a few) may be reduced in vegetarians, but it’s not an absolute cloak of protection.

“This last test, though,” I ran my finger mid-way down the next page, “this other test is significant. It’s an antibody against what we call cyclic citrullinated peptide or CCP, and I’m sorry to say it’s markedly positive. It’s the most specific test we have for the diagnosis of rheumatoid arthritis. There’s no question in my mind; you have early, but very severe, rheumatoid arthritis.”