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Q. I have atrial flutter with positive ANA. Does this confirm that I have rheumatoid arthritis?

Answered by
Dr. Naval Mendiratta
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Oct 24, 2021

Hi doctor,

I am 41 years old and I never had any health issues. Currently, I have an atrial flutter and I am trying to find the cause. My CRP and sedimentation rate in Westergren remains high. I also have positive ANA. Does this confirm that I have rheumatoid arthritis? Could this inflammation be the cause of a faster heart rate? Will the doctor be able to prescribe medicine that eliminates inflammation and faster heart rate? Currently, I am taking an anti-inflammatory diet. Will this eliminate inflammation? Do I need medicine too?

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Hi,

Welcome to icliniq.com.

Thank you for writing. I have gone through your reports and history (attachment removed to protect patient identity). Your ANA (anti-nuclear antibody) remains positive. I would like to ask you a few more questions to be sure of how much ANA is impacting your body. Please mention whether you have dry eyes or dry mouth, any history of oral ulcers, any history of joint pain or rashes, any history of appetite loss or weight loss. Please mention whether your thyroid levels are in the normal range. Please mention whether ANA was advised for the evaluation of atrial flutter or as a part of the routine test.

Coming to your query, atrial flutter seems to be an independent entity. As you do not have rheumatoid arthritis, it does not affect the heart without affecting joints. This strong ANA is usually seen in conditions called lupus or mixed connective tissue disease. Both of them can affect the heart of the myocardium layer. You need to do an echo (echocardiogram) to know whether it is fine. Secondly, you need to do further tests after ANA as well. ENA (extractable nuclear antigen-antibody) profile has to be done to know the antibodies present. Do let me know whether you have any other queries. Regards.

Thank you doctor,

I have a dry mouth and dry eyes. I had joint stiffness in the past. My ANA was done as my doctor wants to know whether I have lupus. My double-strand DNA was negative. My thyroid levels are normal. I had an X-ray seven months back on my C7 neck after having an accident. The X-ray showed some arthritis.

#

Hi,

Welcome back to icliniq.com.

Respected mam, thanks for your reply. As per the symptoms, high ANA can occur due to lupus or mixed connective tissue disease. Double-stranded DNA does not have too much significance unless there is kidney involvement. So you need to evaluate your condition further with the following test. You need to do an ENA profile, complement C3 and C4, and a urine routine. This helps to know whether you are dealing with lupus or any other disorder. The second way is to take a trial of steroids to see whether it can reverse any inflammation around the heart that cause throwing abnormal rhythm. Thirdly, you can add Hydroxychloroquine as well to prevent the disease from evolving further. Hope the information was useful. Do let me know for more queries. Regards.


Investigations to be done:

You need to do an ENA (extractable nuclear antigen antibodies) profile, complement C3 and C4, urine routine, and urine PCR (urine protein creatinine ratio).


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