I found some information that I have included below that answers a lot of your questions. With rheumatoid arthritis and Lupus (SLE) it can take some time for your ANA to reflect properly. I am in that position myself. I am positive one time and negative the next but am being treated with plaquenil due to likely RA or Lupus.
How is it used?
The ANA test is ordered to help screen for autoimmune disorders and is most often used as one of the tests to diagnose systemic lupus erythematosus (SLE). Depending on the patient's symptoms and the suspected diagnosis, ANA may be ordered along with one or more other autoantibody tests. Other laboratory tests associated with presence of inflammation, such as erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) may also be ordered. ANA may be followed by additional tests that are considered subsets of the general ANA test and that are used in conjunction with the patient's clinical history to help rule out a diagnosis of other autoimmune disorders.
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When is it ordered?
The ANA test is ordered when a patient shows signs and symptoms that are associated with SLE or another autoimmune disorder. It may also be ordered when a patient has been diagnosed with an autoimmune disorder and the doctor suspects that the patient may have developed an additional autoimmune disorder. Patients with autoimmune disorders can have a wide variety of symptoms such as low-grade fever, joint pain, fatigue, and/or unexplained rashes that may change over time.
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What does the test result mean?
ANA tests are performed using different assays (indirect immunofluorescence microscopy or by enzyme-linked immunoabsorbant assay - ELISA) and results are reported as a titer with a particular type of immunofluroscence pattern (when positive). Low-level titers are considered negative, while increased titers, such as 1:320, are positive and indicate an elevated concentration of antinuclear antibodies.
ANA shows up on indirect immunofluorescence as fluorescent patterns in cells that are fixed to a slide that is evaluated under a microscope. Different patterns are associated with a variety of autoimmune disorders. Some of the more common patterns include:
Homogenous (diffuse) - associated with SLE and mixed connective tissue disease
Speckled - associated with SLE, Sjogren's syndrome, scleroderma, polymyositis, rheumatoid arthritis, and mixed connective tissue disease
Nucleolar - associated with scleroderma and polymyositis
Outline pattern (peripheral) -associated with SLE
An example of a positive result might be: "Positive at 1:320 dilution with a homogenous pattern."
A positive ANA test result may suggest an autoimmune disease, but further specific testing is required to assist in making a final diagnosis. ANA test results can be positive in people without any known autoimmune disease. While this is not common, the frequency of a false positive ANA result increases as people get older.
Also, ANA may become positive before signs and symptoms of an autoimmune disease develop, so it may take time to tell the meaning of a positive ANA in a person who does not have symptoms. Most positive ANA results don't have significance, so physicians should reassure their patients but should also still be vigilant for development of signs and symptoms that might suggest an autoimmune disease.
About 95% of SLE patients have a positive ANA test result. If a patient also has symptoms of SLE, such as arthritis, a rash, and autoimmune thrombocytopenia, then he probably has SLE. In cases such as these, a positive ANA result can be useful to support SLE diagnosis. Two subset tests for specific types of autoantibodies, such as anti-dsDNA and anti-SM, may be ordered to help confirm that the condition is SLE.
A positive ANA can also mean that the patient has drug-induced lupus. This condition is associated with the development of autoantibodies to histones, which are water soluable proteins rich in the amino acids lysine and arginine. An anti-histone test may be ordered to support the diagnosis of drug-induced lupus.
Other conditions in which a positive ANA test result may be seen include:
Sjögren's syndrome: Between 40% and 70% of patients with this condition have a positive ANA test result. While this finding supports the diagnosis, a negative result does not rule it out. The doctor may want to test for two subsets of ANA: Anti-SS-A (Ro) and Anti-SS-B (La). The frequency of autoantibodies to SSA in patients with Sjögren's can be 90% or greater.
Scleroderma: About 60% to 90% of patients with scleroderma have a positive ANA finding. In patients who may have this condition, ANA subset tests can help distinguished two forms of the disease, limited versus diffuse. The diffuse form is more severe. Limited disease is most closely associated with the anticentromere pattern of ANA staining (and the anticentromere test), while the diffuse form is associated with autoantibodies to the anti–Scl-70.
A positive result on the ANA also may show up in patients with Raynaud's disease, rheumatoid arthritis, dermatomyositis, mixed connective tissue disease, and other autoimmune conditions.
A doctor must rely on test results, clinical symptoms, and the patient’s history for diagnosis. Because symptoms may come and go, it may take months or years to show a pattern that might suggest SLE or any of the other autoimmune diseases.
A negative ANA result makes SLE an unlikely diagnosis. It usually is not necessary to immediately repeat a negative ANA test; however, due to the episodic nature of autoimmune diseases, it may be worthwhile to repeat the ANA test at a future date.
Aside from rare cases, further autoantibody (subset) testing is not necessary if a patient has a negative ANA result.
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Is there anything else I should know?
Some drugs and infections as well as other conditions mentioned above can give a false positive result for the ANA test.
About 3% - 5% of Caucasians may be positive for ANA and it may reach as high as 10% - 37% in healthy individuals over the age of 65.
Some medications may bring on a condition that includes SLE symptoms, called drug-induced lupus. When the drugs are stopped, the symptoms usually go away. Although many medications have been reported to cause drug-induced lupus, those most closely associated with this syndrome include hydralazine, isoniazid, procainamide, and several anticonvulsants.
Thank you for your explanation of ANA, it's appreciated. Sounds like I need more testing for anyone to be sure.
Stress can trigger an autoimmune response in your body, so please don't discount it as a cause for at least some of your symptoms. It can be like the chicken and the egg - stress causes pain, pain causes more stress, which causes more pain, etc.
Make stress management part of your overall self-care plan. It won't hurt, and it might help.
It sounds like you've been doing a lot of research into your symptoms. It's absolutely a good thing to educate yourself, however if you don't know what your dealing with, navigating the confusing labyrinth of symptoms and possible causes can increase your anxiety. (I've been in that place!)
It's possible to have "normal" tests and still have a disease, because each person's "normal" is different. What's normal for one person may be abnormal for you.
Take a step back and begin from square one. Document your symptoms - time of day, pain severity from 1-10, emotional state from 1-10, activity levels, exercise, stress triggers, what you've eaten. You could detect a pattern that you can show your doctor. And it'll keep you focus where it belongs - on your unique body, not what an internet site or a book is telling you.
Hang in there!
Thanks for your response. I have been completely stressed out for a long time now, with mixed symptoms. My daughter recently had a kidney transplant, I am more than certain that would stress ANYONE out!!!! I still do feel that I may have undiagnosed hypothyroid, as I have every single symptom. It's been frustrating trying to get tested for this, as all the standardized tests come back "normal". A positive ANA is the one thing I haven't had in 18 yrs. (they have always been negative) and I am very worried about it. Time will tell on this one!!
Oh wow, you HAVE been dealing with a lot! [[hug]] Is there a support group for parents of transplant kids? Check with the social worker at the hospital - he or she will surely have some resources for you. At the very least, it's a huge relief to talk with someone who knows what you're going through.
FWIW, I have been in a full-blown RA flare-up and my blood tests come back normal. It seems like nothing shows in my blood work until weeks AFTER I start feeling better. Other people with the same diagnosis have measurable sed rates even when they're feeling relatively well.
It's so frustrating when you need your body to function and it not only won't cooperate, it won't tell you what's wrong with it!
Thanks again for your post. There is only one support group for people with transplants (where I live on the West Coast of Florida), but it's for adults....not kids. My daughter is 18, but she is a person with special needs (Autistic) and also has a neurological problem. She is also still in school. I need to hook up with families that have kids like this. It's difficult not having any support for our situation. My daughter had her transplant in the Miami Fl. area and they have a support group, but it's much too far to drive (almost 3 hrs. away).
That's weird that nothing shows up on your blood work, until after a flare up? So this must be a similar effect that is happening to me. Something must be happening and when blood work is done, it shows up after the fact. I am most concerned about the positive ANA, as I was diagnosed years ago with anticardiolipin syndrome (it's now called antiphospholipid syndrome). I had a complete hysterectomy in 2008, went on HRT and now this is happening.....kind of strange? I am wondering if it's all connected somehow? On top of everything else I also have PCOS, but I understand having a hysterectomy doesn't get rid of the disorder.
I see a Rheumatologist today and will be seeing and Endocrinologist in a few weeks. Hope they can solve the mystery. If they cannot -- I will be taking the opposite route and see a holistic physician. Some doctors in the main stream cannot think outside of the box, and continually repeat the same tests over and over again. I just don't understand this type of thinking? It's very frustrating as I have I very specific symptoms.....and have for the past 5 years. Just want to feel GOOD!!!!!!