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Arthritis  (Expert Forum)
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Positive ANA Test
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD Boston - MA
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MedHelp Member's Question

Positive ANA Test

by vanmeter, Apr 24, 2004 12:00AM
I am a forty year old women normally in good health.  I received a positive result on ANA test (1:2560, homogeneous).  Subtest scores were all negative except Anti-scl-70 (2.0), anti-SM (1.1).  I went to the doctor for the following symptoms:  fatigue, anxiety, nausea, cold flashes.  These symptoms came on all of a sudden and have persisted for three months.  I was diagnosed with Hashimoto's 28 years ago.  Could Hashimoto's explain such a high ANA test result.  Over the past five years my TSH has ranged from 29 to .03 with no known cause for the jumps. My TSH, T3, T4 etc. are now in the normal range.  I have been treated for chronic depression for 8 years, but with these current symptoms, my Psychiatrist is convinced that something physical is going on.  I do not have pain in my joints, or extrimities or thickening skin patches to suggest Scleroderma, though I occasionally have difficulty in swallowing.  Is Scleroderma the only autoimmune condition to give a positive Anti-scl-70 result?  According to my lab results anything >1.0 is positive.  Is a positive result just a positive result, or do degrees make a difference.  I am trying to get an appointment with a Cleveland Clinic Rheumotologist, but nothing is available for 5 weeks.  In the meantime, I have not been able to carry out my normally active schedule, and more than that, I am frightened and not sure how to procede.  My internist was not particularly concerned by the ANA test, my endocrinologist was.  Most autoimmune disseases/syndromes are quite rare.  Is it possible that such a large ANA Titer means nothing?  Any information you could provide would be greatly appreciated.
Doctor's Answer

by Kevin Pho, MD, Apr 24, 2004 12:00AM
The presence of very high concentrations of antibody (titer >1:640) should arouse suspicion of an autoimmune disorder. However, its presence alone is not diagnostic of disease. If no initial diagnosis can be made, it is practice to watch the patient carefully over time and to exclude ANA associated diseases.



Although not very sensitive, anti-topoisomerase-I (Scl-70) antibodies are highly specific for systemic sclerosis and correlate with a higher risk of interstitial lung disease. Higher concentrations/titers are also associated with more extensive skin involvement and with higher disease activity.  Anti scl antibodies can also be found in lupus as well as myositis (i.e. muscle inflammatory disease0.  



Anti-Sm antibodies are insensitive (10 to 50 percent depending upon the assay used), but highly specific (55 to 100 percent) for SLE (systemic lupus).  This means that if positive, studies show a 55 to 100 percent correlation to SLE.



A rheumatology consult to discuss these possibilities is recommended.  Studies have shown a correlation between disease severity and the degree of ANA elevation.  Before attributing the large increase in ANA to nothing, I would exclude the aforementioned diseases.  



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.



Bibliography:

Schur.  Antibodies to DNA; Sm; and RNP in systemic lupus erythematosus.  UptoDate, 2004.



Korn.  Overview of the manifestations and diagnosis of scleroderma.  UptoDate, 2004.



Reichlin.  Measurement and clinical significance of antinuclear antibodies.  UptoDate, 2004.
Member Comments (2)

by stamm172, May 13, 2004 12:00AM
I am a 30 yr. old woman who received a pos. ANA test that exhibited a homogeneous pattern in June 2002.  I was referred to a rhemuatoligist who proceded to diagnosis me with psoriatic arthritis and began treatment.  When I asked her about the ANA test, she said that I wasn't having any other major symtoms associated with the test so there was no need to worry with that test.  So, I put that to the back of my head and time went by. Starting in October of 2003 up until now I have had alot of illness and have been referred to neuroligist and a GI specialist.  My symtoms include migraine headaches, for which I was hospitalized for, severe fatigue, pain in my joints, unusual skin rashes on my arms and legs (not resembling psoriosis), memory and concentration problems, and 5 bouts with pluerisy and bronchitis, and recently severe abdominal pain with constant nausea.  I had an EGD this week in which biopsies were taken.  Have not heard back from results.  I was researching online about what I could possibly be going on with me and I came across a link to a lupus website.  After reading everything, I was astonished at how much that sounded like me and I rememered the blood test from June. I went and got a copy of the lab report and everything started to make since for once.  I have still not been diagnosed with Lupus, but I have an appointment very soon in which I will adddress these concerns with my doctor.  Could it be Lupus or all of my symtoms just a coincidence?  Any input would be very appreciated.

by arries, Jun 07, 2004 12:00AM
I've had problems with itchy rashes since 1987, but I have not had the severity of the rashes I still continue to itch and get bumbs and some flair ups occasionaly.  I'm not one to like going to the doctors especialy if they don't know what is happening, so I put things off.  Anyway, in 1991, I was had intermitant swelling in my left ankle up my leg, it would come and go during the day along with strange blochy rashes and it was very painful when swollen.  I had no open wounds and the only recollection I had that I speculated on was that I climed up a pole wraping my legs around it.  Shouldn't be a problem.  I do have a history of left calcaneal fracture and swelling with sometime red itchy rashes prior to this.  Anyway, they never knew what was causing this swelling.  It was speculated that it was an infection, so I was given antibiotics and that didn't help.  Then is was speculated that I had lime disease, and I was sent to a dermatoloigist, and they were not sure, but gave me steroid creams to try nothing worked.  I was in severe pain from the swelling and very agravated.  I stopped going to the doctor because of this agrivation from pain.  I worked in a hospital, so some nurses said it looked like vasculitis or something.  At the end, I went to the emergency room and was given augmentin and that seemed to have solved the problem, I'm not sure it ended up going away.  It was said to have been cellulitis.  I still have itching problems, and I still get RLQ pains though they are more mild then they used to be, so I'm concerned now because I hear that you can get the same rashes internally.  I'm also concerned about my ankle pains and leg pains, but their is no visible swelling.



I'm looking at an old record of an ANA that was 1:640 and according to this the normal range is less than 1:40.  It then says Neucleor ANA Pattern.



Does anyone know what  Neucleor ANA Pattern means?

by MissAlicia, Aug 02, 2007 02:28AM
I'm 19 years old and recently had a postive ANA result of 1.8  According to the test anything about 1.0 is a positive result.

I've recently been suffering from frequent headaches, a fogginess in my head which reduces my ability to concentrate and increases aggitation in me and is making me feel down and depressed...having more mood swings and just not being myself. I also am very tired and fatigued, despite regular exercise.  I recently developed eczema on my eyelids which caused dry, red, itchy eyelids and caused some swelling, as a result of this I've had to limit my eye make up use.  I also have dry eyes sometimes and use over the counter eye-drops to treat this.  Also I have had a huge outbreak of stubborn and inflammed chin acne (my dermatologist put me on doxycycline and it is helping reduce inflammation and redness...however I dont want to be on an antibiotic forever and want to get rid of what is causing the acne and not simply treat the symptom of it).  Also ridges developed on both of my big toe toenails...they started as inflammation of the skin at the base of the nail and then the inflammation went away but left ridges at my toenails which have since been growing out until I can cut them off.

What could this all be from??  Is it Lupus?

by PlateletGal, Aug 02, 2007 11:07AM

My ANA is 1:640 (speckled pattern) and I have CFS.  25% of CFS patients' have a postiive ANA and also have some autoimmunity problems (Dr. David Bell). I believe it was 29% of patients' who have fibromyalgia also have a postiive ANA -- and a large percentage of them, also have a postiive RA.