Free The Autoimmune Connection: Essential Information for Women on Diagnosis, Treatment, and Getting On With Your Life by Rita Baron-Faust, Jill Buyon

be elevated. CRP is normally around 10 mg/L, but in RA it can range from 40 to 200 mg/L.
    Antinuclear antibodies (ANAs) , autoantibodies that react against the nuclear material of cells, are found in the blood of more than 95 percent of women with systemic lupus erythematosus (SLE) and a majority of women with Sjögren’s syndrome, but less than half of women with RA. So a positive ANA may be helpful in distinguishing RA from lupus but, again, keep in mind that the ANA is not specific for lupus.
    A complete blood cell count (CBC) is a standard part of any medical workup. Using laser technology, a machine counts each type of blood cell one by one: red blood cells (RBCs), white blood cells (WBCs), and platelets (cells needed for blood clotting) are differentiated by their size. A CBC can detect anemia (low levels of red blood cells), which often occurs in RA. Your hemoglobin level reflects the oxygen-carrying capacity of red cells; the hematocrit (which is three times the level of the hemoglobin) tells how many red blood cells you have in a given volume of blood. Hemoglobin levels can vary from woman to woman, but the normal range is between 12 and 16 grams of hemoglobin per deciliter of blood (g/dL); a hematocrit ranges from 35 to 47. Either (or both) can diagnose anemia. (Reference ranges vary from lab to lab.) Keep in mind that menstruating females often have lower hemoglobin levels than postmenopausal women do.
    A CBC also measures the number of key white blood cells, like neutrophils, that destroy invading bacteria and viruses by releasing granules of toxic chemicals. In RA, these cells are overactive and multiply. For example, in some RA patients, neutrophils may be depleted (neutropenia), a disorder called Felty’s syndrome that poses an increased risk of infection.
    Other blood tests are done as part of an initial workup to assess organ dysfunction due to coexisting diseases. These tests include liver and kidneyenzymes that indicate organ damage. This is important because some medications used to treat RA can be toxic to the liver or kidneys and can’t be used if these organs are impaired.
    X-rays (doctors call them radiographs or plain films ) are used to determine the degree of joint destruction. An x-ray can show damage to the bones, loss of cartilage, and distortion of the joints, as can magnetic resonance imaging (MRI) and ultrasound. Baseline radiographs are done to provide a reference to assess any future progression of the disease and to help judge the effectiveness of disease-modifying agents. In the early stages of the disease, bone damage will not be evident on an x-ray. In fact, the joints may appear normal except for signs of soft-tissue swelling and some thinning of the bone around the joints. But there can be a rapid progression to the signs considered the hallmark of RA seen on x-rays, MRIs, or ultrasound (sonograms)—the start of bone erosion in areas close to the joint. Sonograms can be done right in your doctor’s examining room.
Kathleen’s story continues:
    I went to see a doctor in Boston who was horrified by the mixture of drugs I was taking, and the first thing he said was, “We have to get you off these drugs.” And he told me to get into a pool, as much as I could as long as I could every day, and just try to swim. So I joined a club in midtown and I started to try to swim. My hands were OK enough that I could hold onto a kickboard, and my hips weren’t affected very much, so I was able to kick straight-legged, and I went back and forth, back and forth, as long as I could stand it. The pain was unbelievable. One day I was able to let go of the kickboard and do a sort of half breaststroke, and that was a great triumph. This was about four years in. One day I got my whole arm to do a stroke, and I stood there in this pool sobbing and yelling, and the poor lifeguard dove in and he grabs me, and I said, “No, no, you don’t understand—I just moved my arm!” From then on I said to