Nicolette: 0:01

Welcome to the Health Pulse, your go-to source for quick, actionable insights on health, wellness and diagnostics. Whether you're looking to optimize your well-being or stay informed about the latest in medical testing, we've got you covered. Join us as we break down key health topics in just minutes. Let's dive in.

Rachel: 0:24

You know, when you're just starting out trying to understand medical conditions, it can be a lot right Like trying to find your way through a maze. Well, today we're going to do a deep dive into a very specific condition. We're focusing on scleroderma and we're going to be using blood tests as our main way to understand it. So this is your kind of like crash course on how doctors use these tools to piece things together.

Mark: 0:48

Yeah, we're diving deep into scleroderma, which is this relatively uncommon autoimmune disease. It's basically like your body's immune system is attacking healthy tissue, and this can affect different parts of your body skin, blood vessels, even internal organs.

Rachel: 1:04

Wow, so for someone, like you said, new to medicine, learning about scleroderma through blood tests, it seems like that's a really valuable place to start. Why is that?

Mark: 1:13

Well, scleroderma can have a whole bunch of different symptoms and it really showcases the power of tools like blood tests. You know you can't just rely on the symptoms you see on the surface.

Rachel: 1:23

Yeah.

Mark: 1:24

Blood tests, let us get a much deeper picture. It helps us understand what's happening beneath the surface.

Rachel: 1:29

Right, right, it's like getting a clue.

Mark: 1:36

Exactly, and this deep dive is going to really highlight how we use blood tests to both diagnose and monitor a condition that's as complex as scleroderma is Okay so our mission today is to figure out the role that blood tests play in managing scleroderma is Okay.

Rachel: 1:43

so our mission today is to figure out the role that blood tests play in managing scleroderma, from the very first suspicion that a doctor might have to the ongoing care that a patient needs. We've got a lot of information here that breaks down these connections, but first let's start with the basics. What exactly is scleroderma?

Mark: 2:01

So scleroderma also goes by the name systemic sclerosis and it's this chronic autoimmune disease. It's kind of like your immune system it's supposed to protect you, but instead it gets confused and starts attacking healthy tissues.

Rachel: 2:13

Oh, that's not good yeah.

Mark: 2:15

Leads to inflammation and after that you get something called fibrosis. Basically, scar tissue builds up and it makes the affected areas stiff and thick. This can happen in your skin, but also in your internal organs, things like your lungs, heart, kidneys, even your digestive system.

Rachel: 2:29

So it's not just a skin condition, then it can impact so many areas of the body.

Mark: 2:34

Exactly. Skin changes are often the most obvious, but the systemic form of scleroderma can affect your whole body and it's worth mentioning there's another kind of localized scleroderma.

Rachel: 2:49

It mostly affects the skin and sometimes the muscle underneath, but usually internal organs aren't involved. That's good to know. So is scleroderma predictable Like? Does it always follow a certain pattern?

Mark: 2:56

Not really no, and that's actually one of the things that makes it difficult to understand and manage. It's very unpredictable. The speed at which it progresses and how it affects different people, the specific symptoms, the organs that are involved, it really varies a lot. Every person is different.

Rachel: 3:11

It sounds like it could be hard to identify. How common is it?

Mark: 3:13

It's considered a rare disease. It's estimated that around 100,000 adults in the United States have it and it's more common in women, usually showing up between the ages of 30 and 50.

Rachel: 3:23

Okay, so just understanding that basic stuff the autoimmune aspect, the fact that it can affect internal organs and how much it can vary from person to person that makes it clear why blood tests are so important. Why are they so crucial for diagnosing scleroderma.

Mark: 3:40

Well, like we talked about, the symptoms can be so different and they can look like symptoms of other conditions too.

Nicolette: 3:45

Right.

Mark: 3:46

So that's where blood tests come in. They're incredibly useful for both diagnosing and monitoring. We have specific antibody tests that can help us figure out if the immune system is going haywire, and we also have inflammation markers that tell us how active the disease is inside the body.

Rachel: 4:02

So let's break down some of these blood tests. First up, the ANA test. What does that tell us?

Mark: 4:07

The ANA that stands for antinuclear antibody test is usually one of the first tests we do when we think someone might have an autoimmune disease. It basically looks for antibodies in the blood that are attacking the nucleus of the cells in your body. Think of it as a signal that your immune system might be turning against you.

Rachel: 4:24

Okay, so what happens, if someone's ANA test comes back positive? What does that mean?

Mark: 4:30

Well, a positive result means that the immune system is attacking the body's own tissues, and for scleroderma, the ANA test is positive in over 90% of cases, so it's a pretty strong indicator. But it doesn't automatically mean someone has scleroderma Right. You could have a positive ANA and have something else, like lupus, rheumatoid arthritis. You can even have a positive ANA and be perfectly healthy. So it's not a diagnosis in itself. It's more like a first clue that leads to more investigation.

Rachel: 5:00

So it's like a starting point.

Mark: 5:01

Yeah.

Rachel: 5:02

What if the ANA test is negative? Does that mean you definitely don't have scleroderma?

Mark: 5:06

A negative ANA makes it less likely, but doesn't rule it out completely. It's rare, but there are cases of scleroderma where the ANA isn't positive.

Rachel: 5:15

Interesting. So let's say, the ANA test comes back positive. What are the next steps? What other blood tests would be ordered?

Mark: 5:22

In that case we'd want to get more specific. We'd order more specific antibody tests to try to narrow down the diagnosis. One of those is the test for anticentromere antibodies, or ACA.

Rachel: 5:33

ACA. What do those antibodies tell us?

Mark: 5:35

So these antibodies target proteins in the centromeres, which are parts of the cell nucleus. If someone has ACA, it's especially helpful for identifying a specific type of systemic scleroderma. It's called limited cutaneous systemic sclerosis, and this form is often linked to something called CREST syndrome.

Rachel: 5:52

I've heard of that.

Mark: 5:53

Yeah, and that stands for calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly and telangieca. It's basically a bunch of specific symptoms.

Rachel: 6:03

What are some of the things that characterize that limited cutaneous type?

Mark: 6:07

Well, the skin thickening isn't as widespread and the disease tends to progress more slowly. But and this is important even if the skin involvement is milder, you can still have serious internal complications like pulmonary hypertension, which is high blood pressure in the arteries of your lungs.

Rachel: 6:23

Wow. So even if the ACA suggests a slower progression, there's still a risk. Okay, Now I also see mention of another antibody test, anti-CL70. How is that different from the ACA test? What does it tell us?

Mark: 6:37

So anti-CL70 is also called antitopizomerase antibodies. It's another antibody that's very specific to scleroderma, but it's more common in people with diffuse systemic scleroderma. That's the type where the skin thickening is more widespread and the progression can be faster.

Rachel: 6:54

So it sounds like there are some key differences between those two antibody tests.

Mark: 6:58

Yeah, and there can be differences in the internal organ involvement too.

Rachel: 7:01

Right.

Mark: 7:01

When someone has anti-CL70, they have a higher chance of developing interstitial lung disease or ILD. That's basically scarring of the lung tissue, and some research suggests that it might also be linked to a faster disease progression overall. So if we find anti-CL70, it's a warning sign that we need to keep a close eye on the lungs.

Rachel: 7:20

It's amazing how these specific antibodies can tell us so much. It's like getting a sneak peek at what might happen.

Mark: 7:26

Absolutely, they help us anticipate potential complications. Yeah, and that lets us adjust our monitoring and treatment strategies to fit each patient.

Rachel: 7:33

Okay, that makes sense. So we've talked about those specific antibody tests, but there are some other blood tests that can be helpful too, right, even though they're not specific to scleroderma.

Mark: 7:43

Right. We also look at the ESR and CRP.

Rachel: 7:46

Oh yeah, I remember reading about those. Those are markers of inflammation, right.

Mark: 7:55

You got it. Esr stands for erythrocyte sedimentation rate and CRP stands for C reactive protein. They're not unique to scleroderma. They just tell us that there's inflammation somewhere in the body. They might not always be elevated in people with scleroderma, but they can go up during flare-ups or if there are complications like lung or kidney problems and we can use them to see how well treatment is working. If the inflammation goes down, that's a good sign.

Rachel: 8:17

So they're like a general indicator of how much inflammation is going on. What about a complete blood count or CBC? What does that tell us about scleroderma?

Mark: 8:26

The CBC is a pretty standard blood test. It looks at all the different types of blood cells Red blood cells, white blood cells and platelets and if we see anything unusual in those counts it can point us in the right direction. For instance, if someone has anemia, that means they have a low red blood cell count, and that can happen with scleroderma. Or we might see low white blood cells, which is called leukopenia, or low platelets, which is thrombocytopenia. These things can be a sign of autoimmune activity, chronic inflammation. They can even suggest complications like GI bleeding from esophageal ulcers, which can sometimes occur in scleroderma.

Rachel: 9:03

Wow, so much information can be gleaned from a simple blood test, right. What about the Comprehensive Metabolic Panel, or CMP? What's the main purpose of that one?

Mark: 9:12

The CMP is a set of tests that looks at how well a few key organs are functioning, mainly the liver and kidneys.

Rachel: 9:17

Okay.

Mark: 9:18

And this is super important for scleroderma because it can help us catch serious complications early on, like scleroderma renal crisis. What's that? It's a sudden and dangerous increase in blood pressure, and it can lead to kidney failure. The CMP can also show us if there were any liver problems which could be caused by the medication someone's taking. Plus, it gives us baseline information about organ function that we can track over time.

Rachel: 9:44

It sounds like all these different blood tests really give a complete picture of what's going on.

Mark: 9:48

They do.

Rachel: 9:49

I also read about something called an autoimmune panel. What's usually included in that?

Mark: 9:53

Ah yes, An autoimmune panel is like a broader screening.

Rachel: 9:57

Okay.

Mark: 9:57

We use it to look for a whole bunch of different antibodies at the same time. It might include some of the scleroderma antibodies we already talked about, but it can also include antibodies that are more typical of other autoimmune conditions. Sometimes these conditions can overlap with scleroderma. For example, it might check for RNP antibodies those are seen in mixed connective tissue disease, or it might look for SSSSB antibodies, which are associated with Sjogren's syndrome. It could even include rheumatoid factor and anti-CCP antibodies to see if the patient also has rheumatoid arthritis.

Rachel: 10:30

So it's like casting a wider net just to make sure you're not missing anything.

Mark: 10:34

Exactly. It helps us figure out not only if someone has clariderma, but also if they might have another autoimmune condition on top of that, which means we might need to adjust the treatment.

Rachel: 10:45

We've spent a lot of time talking about how blood tests help diagnose scleroderma, but it's a chronic condition, so monitoring must be really important too, right?

Mark: 10:54

Absolutely. Scleroderma can change over time, so it's really important to keep track of what's going on. Regular blood work is key for managing it effectively. It's like checking in with the body and seeing how things are progressing.

Rachel: 11:06

So which blood tests are usually used for monitoring?

Mark: 11:10

how things are progressing. So which blood tests are usually used for monitoring? Well, a lot of the ones we've already talked about the ESR and CRP, are still important for monitoring inflammation. The CBC helps us track blood cell counts which can be affected by the disease itself or by some of the medications, and the CMP is essential for keeping an eye on the kidneys and liver. We want to make sure they're functioning properly.

Rachel: 11:29

Are there any other blood tests that might be used specifically for monitoring scleroderma or checking for complications?

Mark: 11:36

Yeah, there are a few others. It depends on what symptoms the patient's having. For instance, if we're concerned about muscle involvement, we might order a creatine kinase test, or CK for short, or we might do an aldolase test. These are enzymes that are released when muscle tissue is damaged. And if we want to check on heart function and look for signs of pulmonary hypertension, we might use tests like NT-PRO-BNP or BNP.

Rachel: 11:59

So how often would someone with scleroderma need to get these blood tests done?

Mark: 12:05

It really varies. It depends on the type of scleroderma they have, how severe it is, which organs are affected and how stable their condition is overall. Usually, some tests are done every three to six months just for routine monitoring, but if someone's having a flare-up or if we've changed their treatment, we might do them more often. It really all comes down to the individual patient and what they need.

Rachel: 12:24

Wow, that's a lot to take in, but this whole process, from the initial suspicions to the ongoing monitoring, it really highlights how important lab tests are for understanding and managing scleroderma.

Mark: 12:35

It does, yeah, and it shows how we use different types of tests, some general, some very specific along with the ability to monitor changes over time. It's like putting together a puzzle. We use all these pieces to get a clear picture of what's going on and figure out the best way to care for each patient.

Rachel: 12:52

So if there's one key takeaway about blood tests and scleroderma, what would it be?

Mark: 12:57

Blood tests are absolutely vital, not just for diagnosing scleroderma, but also for monitoring it over time. They give us crucial information about how active the disease is, what parts of the body might be affected and whether there are any new complications developing.

Rachel: 13:12

So it's like a window into what's happening inside the body.

Mark: 13:15

Exactly.

Rachel: 13:15

And how does all this fit into the bigger picture of medicine? You know, how do scleroderma and blood tests reflect the way we approach other medical conditions?

Mark: 13:24

It really shows a fundamental principle of medicine. Lab tests are essential. They're a cornerstone of how we understand and manage so many medical conditions. They give us objective data, hard facts, and that helps us unravel the mystery of what's causing the disease, and it allows us to make informed decisions about the best way to treat our patients.

Rachel: 13:45

That's a really important thing to keep in mind, especially for someone who's just starting out in medicine. It makes you realize how many conditions rely on these tests for diagnosis and treatment. Well, thanks for joining us today for this deep dive into the world of scleroderma and blood tests. It's been fascinating.

Mark: 14:02

My pleasure.

Rachel: 14:02

And for all of you, listening, keep exploring. There's always more to learn. There's always more to learn.

Nicolette: 14:12

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