Anti-Nuclear Antibody Test: What Does it Mean?

[Guest guest]

Anti-Nuclear Antibody Test: What Does it Mean?

Getting a diagnosis can take weeks, or even years. It's like a

Polaroid photograph that takes time to develop. The clinical history

is most important. That's why it's so important that your doctor is a

rheumatologist familiar with treating lupus. And it's important that

you keep track of your symptoms, so you can tell the doctor what has

been going on.

Unlike some other conditions that are easily diagnosed with a single

lab test, with lupus, it's not so easy. This is no surprise, because

many things are not easy with lupus! One lab test will not be enough

because of the systemic nature of lupus. Systemic Lupus Erythematosus

(SLE) can affect so many systems, or parts of the body. If you ever

feel like all of your parts have been under the microscope, that's

why! The auto-antibody blood tests are the most helpful for

diagnosing lupus. That's because, as an autoimmune disease, lupus

causes the body to attack itself.

The test that causes the most concern and from my mail, the most

frustration, is the Antinuclear antibody (ANA) test. The ANA test is

important because it shows the body is acting against the nucleus of

the cell, where the commands are sent out. The majority of persons

with lupus will have a positive ANA test. However, lupus is not the

only condition that will result in a positive ANA. Some medications,

infections, and other diseases also can come out positive. A positive

ANA is just one piece of the diagnosis puzzle.

Other autoantibody tests are more specific to lupus. However, not all

persons with lupus test positive for them. Some examples are: anti-

DNA, anti-Sm, anti-RNP, anti-Ro

(SSA), and anti-La (SSB). Your doctor

may order these additional tests to try to make a diagnosis.

Now, let's get to the nitty gritty. What's all this

talk about

titers? Here's a Q & A session between doctor and patient on this

topic.

Q1. My question is " What is

considered a high ANA titer for lupus? My

blood work will say 'Titers of 1:160 and greater should be considered

highly suggestive of connective tissue disease'. But my ANA's

sometimes are l:l60 and l:40 and then last time it was less than

l:40.

A1. ANA reports include a titer

(number) and a pattern. The titer

tells us how many times the technician had to dilute plasma from the

patient's blood to get a sample free of the anti-nuclear antibodies.

Thus, a titer of 1:640 shows a greater concentration of anti-nuclear

antibodies than a titer of 1:320 or 1:160.

ANA titers go up and down during the course of the disease, and a

high or low titer does not necessarily mean the disease is more or

less active. A titer above 1:80 is usually considered positive.

However, some laboratories may interpret different titer levels as

positive, so one cannot compare titers from different laboratories.

Q2. My rheumatologist doesn't help much

because he goes a lot by

whether my sed or sedimentation, rate is

elevated and other factors.

I always have ANA titers in speckled pattern - do not know what that

is either?

A2. The pattern of the ANA test can

sometimes be helpful in

determining which autoimmune disease is present and which treatment

program is appropriate. The speckled pattern is found in SLE and

other connective tissue diseases, while the peripheral or rim pattern

is found almost exclusively in SLE.

Because the ANA is positive in so many conditions, the results of the

ANA test have to be interpreted in light of the patient's medical

history, as well as his or her clinical symptoms. Thus a positive ANA

alone is NEVER enough to diagnose lupus. On the other hand, a

negative ANA argues against lupus, but does not rule the disease out

completely.

From- Laboratory Tests Used in the Diagnosis of Lupus

Reichlin, M.D., Professor of Medicine and

Chief, Immunology

Section, University of Oklahoma Health Sciences Center, Oklahoma

City, OK

Published by the Lupus Foundation of America.

Remember the big picture of the process of diagnosing Lupus.

Diagnostic tools include:

Medical history

Complete physical examination

Laboratory tests:

Complete blood count

Erythrocyte sedimentation rate (ESR) - an elevated ESR indicates

inflammation in the body

Urinalysis

Blood chemistries

Complement levels - often low in people with lupus, especially during

a flare

Antinuclear antibody test (ANA) - positive in most lupus patients,

but a positive ANA test can have other causes

Other autoantibody tests (anti-DNA, anti-Sm,

anti-RNP, anti-Ro [sSA],

anti- La [sSB]): One or more of these tests may be positive in some

people with lupus

Syphilis test - may be falsely positive in people with lupus

Skin or kidney biopsy

Getting a diagnosis of lupus can be a pain-staking process. However,

sometimes isn't it just better to know? Symptoms are managed for many

with anti-inflammatory medications, and drugs to dampen down the

immune system, like Plaquenil. Your doctor may want a

definite

diagnosis before proceeding with the treatment. Lupus is no longer a

death sentence. Most people with lupus will live a normal lifespan.

Shop around this site for more information on living better with

lupus.

Hugs,

Deanna