Re: ANA

[Guest guest]

anyone dealt with ANA, I'm told I could go to

> a rhumatologist, but it just might be the PSC causing the positive

ANA

> (Anti-nuclear antigens)...thanks

>

> Barbara in land

>

Barbara,

I don't have a researched answer for you, but I can tell you that I've

had a positive ANA, too. During the diagnosis phase, they kept trying

to say I had autoimmune hepatitis (AIH) because of my positive ANA and

other things, too. It wasn't until the ERCP that they said, " Nope,

definately PSC. " I was one of the people whose liver enzymes

normalized or improved (at various stages of the disease) on

prednisone. I wonder if the positive ANA is an indicator of the

AIH/PSC overlap syndrome? My mother has rheumatoid arithritis - wonder

if I live a long life if that will show up, too? Time will tell, I

guess...For now, I'm not troubling trouble!

Take care,

Deb in VA

PSC 1998, UC 1999, Listed Ltx 2001, LDLTX 5/19/2005... updates at

www.caringbridge.org/va/deniseb

[Guest guest]

Hi Barbara;

ANA (antinuclear antibodies) are usually associated with autoimmune

hepatitis type 1 (AIH-1). But there is evidence that AIH and PSC can

sometime co-exist in an " overlap syndrome " , and that AIH can

sometimes " evolve " into PSC. Usually, AIH responds to

immunosuppression, but PSC doesn't. I can provide references if you

are interested?

Best regards,

Dave

(father of (20); PSC 07/03; UC 08/03)

> Diagnosd with PSC last year, but have had positive ANA since the

80's - with no real understanding of it or treatment ... had

necrotizing pancreatitis in 98, ... anyone dealt with ANA, I'm told I

could go to a rhumatologist, but it just might be the PSC causing the

positive ANA (Anti-nuclear antigens)

[Guest guest]

Hi Barbara;

ANA (antinuclear antibodies) are usually associated with autoimmune

hepatitis type 1 (AIH-1). But there is evidence that AIH and PSC can

sometime co-exist in an " overlap syndrome " , and that AIH can

sometimes " evolve " into PSC. Usually, AIH responds to

immunosuppression, but PSC doesn't. I can provide references if you

are interested?

Best regards,

Dave

(father of (20); PSC 07/03; UC 08/03)

> Diagnosd with PSC last year, but have had positive ANA since the

80's - with no real understanding of it or treatment ... had

necrotizing pancreatitis in 98, ... anyone dealt with ANA, I'm told I

could go to a rhumatologist, but it just might be the PSC causing the

positive ANA (Anti-nuclear antigens)

[Guest guest]

ANA= Antinuclear antibodies. It is one of those frusterating tests in

medicine that usually is misleading and doesn't help diagnose anything.

Basically it is a test of serum antibodies that stick to cell nuclei.

it is usually reported in titers i.e. 1:16 or 1:32 are low level

because they are detectable when the serum is diluted 16 or 32 time

1:64, 1:128 mean higher levels and are more likely to indicate a

problem. ANA is used as just one of several criteria to dianosis

Lupus but most positive test occur without lupus.

PSC and other liver diseases change the immune system to cause more

false positivies for this and other antibody tests.

Below is an explaination from a rhematologic point of view. It's

probably more than you would ever want to know. The direct link is

http://www.lupus.org/education/articles/ana.html

My ANA Is Positive. . .What Does That Mean?

S. Leisy

LFA Online Health Educator

A reprint from the Lupus Foundation of America Lupus News, Volume 18 ·

Number 1 · Winter 1997-98

--------------------------------------------------------------------------------

You went to the doctor, told your story, and were examined. Your

doctor said, " We're going to draw some blood and run some tests. " You

asked, " What kind of tests? " The doctor replied, " Oh, rheumatoid

factor, ANA, sed rate, blood count and some others. " A week later you

asked for the results of your blood tests and were told, " Your ANA

test came back positive. "

Diagnosing lupus is a complex process. It's not as simple as

diagnosing a broken bone, strep throat, or pregnancy. In these

conditions there are simple tests which, if positive, point to a

single diagnosis. There is no single diagnostic test for lupus. There

is a screening test called the ANA (anti-nuclear antibody) test which

is often checked when a doctor suspects lupus. If the ANA test comes

back negative it is considered a normal result, and it is very good

evidence against lupus as an explanation for the symptoms. If the ANA

test result comes back above the normal range the test is said to be

positive. A positive ANA test by itself is not proof of lupus.

Understanding the positive ANA test

What does a positive ANA mean? Unlike a pregnancy test, which if

positive generally means only one thing, a positive ANA can mean many

things. There are many illnesses and conditions associated with a

positive ANA, including rheumatoid arthritis, Sjogren's syndrome,

scleroderma, and lupus, as well as infectious diseases such as

mononucleosis, subacute bacterial endocarditis, and autoimmune thyroid

and liver disease. Certain medications can cause a positive ANA, and

many healthy people with no associated illness or condition have a

positive ANA. In fact, about 5% of the general population will have a

positive ANA yet fewer than 1 in 1,000 have lupus. Thus, at least 95%

of the people who have a positive ANA do not have lupus! A positive

ANA test can sometimes run in families, even if family members have no

evidence of lupus. The ANA is only a test and, like a high cholesterol

value, a positive ANA doesn't necessarily equate having a disease. A

positive ANA is only an indicator which points in several possible

directions, and indicates that further investigation and analysis may

be needed.

How does your doctor use the ANA result?

The doctor will view your ANA and other lab results in light of your

history and physical exam to determine if there is sufficient evidence

to diagnose a specific illness. None of the connective tissue (joints,

tendons, cartilage, collagen, muscles and skin) diseases has specific

diagnostic tests. Diagnosis is therefore based on meeting certain

criteria for the disease which are based on the symptoms you have had,

your physical examination, and your blood tests. In systemic lupus,

eleven criteria were developed for research purposes but are

frequently used to diagnose lupus.

Usually, physicians do not make a diagnosis of lupus unless they

determine that the patient has at least four criteria. If only two or

three criteria are met, then there may not be enough evidence to

support a diagnosis of lupus. Since not all of the criterion are black

and white, a physician may sometimes be uncertain whether a patient

meets a particular criterion or not. This adds to the difficulty in

diagnosis.

Furthermore, if another disease or condition can explain the presence

of the criterion in a patient, then it may not indicate lupus.

Therefore, it's possible to meet four criteria, and not have lupus.

Why does it take so long to know " for sure " ?

If your ANA is positive and you have many symptoms, your doctor may

suspect some kind of connective tissue disease. If at that time there

aren't enough symptoms and lab work to satisfy the criteria for any

one disease, then it is impossible to specify a particular disease or

to confirm a diagnosis.

Lupus tends to develop slowly and evolve gradually over time. Many-or

even most-people who have just a few of the criterion for lupus never

develop this or any other connective tissue disease, and either

improve or continue as they are.

Awaiting a diagnosis can be frustrating. If only one or two criteria

are satisfied, it's similar to a picture that's only partially

developed. No one looking at that picture can accurately identify it.

Nor can they predict if it will develop into anything that can be

identified, how long it will take before it is developed enough to

identify, or if it will develop further at all!

There is no way to hurry the diagnosis of lupus. The length of time it

takes can be highly variable; it may take weeks, months or years. In

some cases, it can take as long as 10 years before enough evidence

accumulates indicating that it is, in fact lupus.

Learn the signs and symptoms of lupus so that if you develop something

new, you can tell your doctor so s/he can determine if you have

satisfied enough criteria for a diagnosis.

What about a " borderline " ANA?

All tests have a normal range of values. If a test value is at the

upper limit of the normal range or slightly over, it's often referred

to as " borderline. " The importance of a borderline ANA test depends on

the other criterion that are present. A borderline positive ANA will

probably be ignored by the doctor if there are only one or two other

criterion suggesting lupus, yet could clinch the diagnosis if there

are already three or four positive criterion.

Is it possible to have lupus with a negative ANA?

More than 95% of people with systemic lupus have a positive ANA. Only

a small percentage have a negative ANA, and many of those have other

antibodies (such as anti-phospholipid antibodies, anti-Ro, anti-SSA)

or their ANA converted from positive to negative from steroids,

cytotoxic medications, or uremia (kidney failure).

How high does my ANA have to get before the doctor says it's lupus?

It is not a question of how high the ANA titre is. Even a very high

" titre' ANA by itself is never sufficient to diagnose lupus. Other

criteria must be satisfied.

A titre (ti-ter) is the number of times a solution (such as a person's

blood) can be diluted before a substance (such as an antibody) can no

longer be detected. Thus, an ANA titre of 1:80 means that the blood

can be diluted to one in eighty parts and the lab technician can still

detect the ANA antibody. The dilutions are usually two-fold, so that

the next dilution would be 1:160, and the one after 1:320.

Because normal ranges for ANA titres vary from lab to lab, there is no

universal normal range. There is no limit to how high the ANA can go.

>

> Diagnosd with PSC last year, but have had positive ANA since the 80's -

> with no real understanding of it or treatment ... had necrotizing

> pancreatitis in 98, ... anyone dealt with ANA, I'm told I could go to

> a rhumatologist, but it just might be the PSC causing the positive ANA

> (Anti-nuclear antigens)...thanks

>

> Barbara in land

>