I have fatigue and soreness for a long period, and all my ANA tests are positive. Please help.

Hi,

Welcome to icliniq.com.

I have gone through your query, and I can understand your concern. Positive ANA (anti-nuclear antibodies) is seen in various rheumatological disorders like lupus erythematosus, scleroderma, myositis, mixed connective tissue disease, etc. But its positivity by itself does not mean anything. ANA should be positive along with other clinical symptoms like joint pain, rash, photosensitivity, and so on to be of any importance. Also, the level of ANA should be high to be considered significant atleast 1:160 or more. As it can be positive even in normal asymptomatic individuals up to 20% below 1:160. So in your case, if you do not have any symptoms isolated ANA positivity is just incidental and does not denote any active rheumatoid disorder. It will mean that you may tend to develop an autoimmune condition. In your case, I would like to know,

1. Why ANA test was done?

2. Did you have any suggestive symptoms?

3. Is there a history of prior autoimmune disease like autoimmune thyroiditis? As you have mentioned, you are taking Synthroid (Levothyroxine), which is given for hypothyroidism.

If you have any other questions, you can always revert here.

Thank you.

Hi,

Welcome back to icliniq.com.

Symptoms of excessive fatigue and soreness are challenging to quantify objectively, and sometimes they can be ignored as the specific cause cannot be found. But if they are significant causing problems in day-to-day work. I would consider investigations. As these symptoms are non-specific, pointing out a single cause is difficult, and most reasons can be multifaceted. We need to correct from many angles to see what is working. In your case, both vitamin D deficiency and Hashimoto’s thyroiditis can cause symptoms of fatigue and joint pain. I would consider starting vitamin D and calcium supplements with titrations of Synthroid, keeping TSH (thyroid-stimulating hormone) below 2 mIU/L. Also, Hashimoto's thyroiditis can have systemic features of autoimmune diseases like arthralgia, rash, and fatigue. Positive ANA with Hashimoto's thyroiditis will denote a tendency for autoimmune disorders, but as there are no other symptoms, it is not diagnostic of any other rheumatoid disorders. Also, your polycythemia brings many questions like,

1. What is the cause for it?

2. Is it primary polycythemia vera where bone marrow is problematic?

Polycythemia causes inflammation leading to persistent fatigue. I need to see your old reports of CBC (complete blood count), ESR (erythrocyte sedimentation rate), TPO (thyroid peroxidase) to confirm. Right now, for ANA, you need not consult a rheumatologist. I suggest regularizing thyroid medication and vitamin D supplements. And we may need to look more into the cause of polycythemia.

If you have any other questions, you can always revert here.

Thank you.