I just got a hold of some test results from my Rheumy yesterday. When she left the room I had one of her med assistants make a copy for me. I noticed on one of the blood tests she performed on me last year (Oct. 08), the Anti Nuclear Antibody Screen, it was recommended by the lab, based on my result, that I should be tested for the specific autoantibodies indicative of the various systematic rheumatic diseases. She has never tested me for this afterwards!!!!! Can someone tell me what these are???? I am in the dark on this now. Is there another test she should now be performing on me?
Does this mean there is a chance that I have RA? She has only diagnosed me with Fibromyagia, but RA and other more insidious forms of arthritis runs in my family. I feel as though I am undertreated. Thanks in advance for your responses.
Yes, you should have those tests. Confront her and ask why or go to a new doctor. I've had issues with my GP ignoring instructions from my rheumy who is treating me from afar. It is very frustrating to have your treatment sidelined by a lazy doctor.
It's actually my Rheumy who decided not to perform the additional test. My Rheumatologist is the only one in town who also treats fibro too and I think she makes a killing on diagnosing fibro.
I just found out a year later that I had a questionable ANA screening. I am wondering why though that she chose not to pursue more testing when the lab said she should? I don't know much about ANA antibody testings? What diseases can they reveal?
Here is an article that details more about the test and some of the causes of a positive result:
Types of Antibodies
In order to understand the ANA (antinuclear antibody) test, it is first important to understand different types of antibodies.
Antibodies are proteins, produced by white blood cells, which normally circulate in the blood to defend against foreign invaders such as bacteria, viruses, and toxins.
Autoantibodies, instead of acting against foreign invaders as normal antibodies do, attack the body's own cells.
Antinuclear antibodies are a unique group of autoantibodies that have the ability to attack structures in the nucleus of cells. The nucleus of a cell contains genetic material referred to as DNA (deoxyribonucleic acid).
There is an ANA (antinuclear antibody) test which can be performed on a patient's blood sample as part of the diagnostic process to detect certain autoimmune diseases.
ANA (Antinuclear Antibody) Test
To perform the ANA (antinuclear antibody) test, sometimes called FANA (fluorescent antinuclear antibody test), a blood sample is drawn from the patient and sent to the lab for testing.
Serum from the patient's blood specimen is added to microscope slides which have commerically prepared cells on the slide surface. If the patient's serum contains antinuclear antibodies (ANA), they bind to the cells (specifically the nuclei of the cells) on the slide.
A second antibody, commercially tagged with a fluorescent dye, is added to the mix of patient's serum and commercially prepared cells on the slide. The second (fluorescent) antibody attaches to the serum antibodies and cells which have bound together. When viewed under an ultraviolet microscope, antinuclear antibodies appear as fluorescent cells.
•If fluorescent cells are observed, the ANA (antinuclear antibody) test is considered positive.
•If fluorescent cells are not observed, the ANA (antinuclear antibody) test is considered negative.
How is the ANA titer determined?
A titer is determined by repeating the positive test with serial dilutions until the test yields a negative result. The last dilution which yields a positive result (flourescence) is the titer which gets reported. For example, if a titer performed for a positive ANA test is:
The reported titer in our example is 1:160.
Three parts of an ANA report
An ANA report has three parts:
•positive or negative
•if positive, a titer is determined and reported
•the pattern of flourescence is reported
What is the significance of the ANA pattern?
ANA titers and patterns can vary between laboratory testing sites, perhaps because of variation in methodology used. These are the commonly recognized patterns:
•Homogeneous - total nuclear fluorescence due to antibody directed against nucleoprotein. Common in SLE (lupus).
•Peripheral - fluorescence occurs at edges of nucleus in a shaggy appearance. Anti-DNA antibodies cause this pattern. Also common in SLE (lupus).
•Speckled - results from antibody directed against different nuclear antigens.
•Nucleolar - results from antibody directed against a specific RNA configuration of the nucleolus or antibody specific for proteins necessary for maturation of nucleolar RNA. Seen in patients with systemic sclerosis.
What does a positive ANA result mean?
ANAs are found in patients who have various autoimmune diseases, but not only autoimmune diseases. ANAs can be found also in patients with infections, cancer, lung diseases, gastrointestinal diseases, hormonal diseases, blood diseases, skin diseases, and in elderly people or people with a family history of rheumatic disease. ANAs are actually found in about 5% of the normal population.
The ANA results are just one factor in diagnosing, and must be considered together with the patient's clinical symptoms and other diagnostic tests. Medical history also plays a role because some prescription drugs can cause "drug-induced ANAs".
What is the incidence of ANA in various diseases or conditions?
Statistically speaking the incidence of positive ANA (in percent) per conditon is:
Subsets of the ANA (antinuclear antibody) test are sometimes used to determine the specific autoimmune disease. For this purpose, a doctor may order anti-dsDNA, anti-Sm, Sjogren's sydrome antigens(SSA, SSB), Scl-70 antibodies, anti-centromere, anti-histone, and anti-RN.
The ANA (antinuclear anibody) test is complex, but the results (positive or negative, titer, pattern) and possible subset test results can give physicians valuable diagnostic information.
Ok, but this test was a screening that I had. Is it different? The ranges were 0-10 U/mL and it clearly stated that anyone testing less than 10 should be tested for the specific autoantibodies for the indicative rhuematic diseases. Why wouldn't she have done further testing? Could it be because my RA factor and sed rate was so low? I am confused and can't believe that Fibro could be causing all of this pain and debilitation.
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