Comment by y-c-o-m-b | Hacker News Reader

Comment by y-c-o-m-b | Hacker News Reader

This is fantastic and a great step in the right direction, especially with the new treatments (mentioned in the article also). Unfortunately we still have doctors that either do not care enough or are not skilled enough to order simple blood tests.

Me, my wife, and my father all have various auto-immune issues. It's been a frustrating fight on all three fronts to get any sort of testing done. For myself this has spanned over a decade now. My dad's journey is just starting, but we've had to switch specialists numerous times to get one that would actually DO something.

For my wife, we begged two previous PCPs for years to get an ANA and rheumatoid factor panel done because I suspected she had rheumatoid arthritis. Those tests are simple and more importantly, they're cheap. No reason to not do them in the context of patient's complaints about chronic pain, especially if they provide peace of mind and rule out serious causes. PCPs consistently brushed it off as anxiety and stress. We finally found a new PCP to take it seriously, so lo and behold: positive blood tests for both ANA and Rheumatoid Factor!

It's absurd that we have all these tools available to us, but they're not being utilized in many valid cases where they'd be useful. So while the article mentions this would be a way to start treatment early by detecting the disease earlier, I have low confidence in the health system to take that initial step.

For context Rheumatoid Factor is present in 4% of the healthy population, an even upto 30% in certain populations like native Americans [1]

ANA is positive in 15% of the population [2]

The idea that the tests rule out serious causes is not really correct, people can have seronegative inflammatory arthritis in which case these tests are negative. Peace of mind is dubious as well given that even with a positive test you are still more likely to not have an inflammatory arthritis.

It’s a common misconception that blood tests are binary and provide concrete answers. Sometimes they do. But most blood tests, like many measurements, are far from binary and have a distribution across the normal population, once it passes an arbitrary threshold it does not necessarily mean you have disease X, context (clinical history and examination) are often far more important in making a diagnosis.

Unfortunately some of the population tend to overweight blood tests vs a physicians assessment, I guess they see the former as an objective measure and the latter as subjective. Especially because if you shop around enough clinicians you’ll eventually find one who will say what you want to hear and that one will inevitably be ‘right’.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3845430/ 2. https://rheumatology.org/patients/antinuclear-antibodies-ana...

Thanks for the information. I've been diagnosed with seronegative inflammatory arthritis myself, so I understand that the blood tests are not perfect; and "rule out" was used loosely to mean "unlikely to have". All of which is not really relevant to my point. My point was that health practitioners have become too comfortable with using anxiety (without evidence) to brush off patient concerns instead of utilizing cheap diagnostic tests to aide in the exploratory process of diagnosing a patient accurately.

In the case of my wife, once both blood tests came back positive, she was properly referred to a rheumatologist to continue monitoring her symptoms and their progression. That is how the healthcare system is supposed to work. Run tests, if it comes back positive, keep investigating with the right specialists that are more experienced in the area, then continue to look for signals that a diagnosis is accurate. Not this hand-wavy speculation with lack of evidence we experienced early on. Now that she has started to develop rheumatoid nodules, it's becoming more accepted by her healthcare team that this is rheumatoid arthritis.

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