ANA Test Follow-up

[hisbutterfly]

My dr. did a follow-up ANA test.  My first test came back 1:80 Homogeneous.  This test came back 1:160 Speckled and Homogeneous.  She is going to retest again when I see her next.  I didn't see the actual results until I left her office.  I'm wondering what the different patterns mean - why the first one would be Homogeneous only and then the next one be both Speckled and Homogeneous.  I understand the Titer.  She wasn't concerned because she considers 1:160 to still be a low positive.  She just said she'd keep watching it.

[Red_Star]

To add, rim pattern is also known as peripheral pattern.

[Red_Star]

"Richard Silver, M.D., Professor of Medicine, Medical University of South Carolina (originally published in "Scleroderma Voice," 2002 Issue #1)

Question: When you have a positive ANA titer (concentration), can the pattern change, and if so, what does this mean? Is the pattern of the titer indicative of the disease you could develop?

Answer: Both the pattern and the titer (concentration) may change, and certain patterns are indicative of specific autoimmune diseases.

For example, the anti-centromere and the anti-nucleolar patterns are fairly specific for scleroderma, but other patterns such as the speckled pattern may be seen in both scleroderma and other connective-tissue diseases.

Generally, the ANA test is used by the rheumatologist to help support or refute a clinical impression; neither the pattern nor the titer is used to monitor the course of disease. Changes in pattern and titer are relatively insensitive, and therefore not very useful for the clinician."

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.


Rim Pattern:
Systemic Lupus Erythematosus (Most Specific)

Homogenous Pattern:
Systemic Lupus Erythematosus (SLE) (Very specific)

Further evaluation
Anti-dsDNA
Anti-ssDNA
Anti-Smith

Speckled Pattern:
Most common, least specific

Disorders
Systemic Lupus Erythematosus
Mixed Connective Tissue Disease
Scleroderma
Sjogren's Syndrome

Further evaluation
Smith Antibody (Anti-Smith)
Ribonucleoprotein Antibody (Anti-RNP)
Scl-70 kD kinetochore (Anti-Topoisomerase I)
Anti-La (Anti-SSB)

Nucleolar Pattern:

Disorders
Scleroderma
CREST syndrome

Further evaluation
Scl-70 kD kinetochore (Anti-Topoisomerase I)
PM-1

Diffuse Pattern:
Non-specific pattern

Centromere Pattern:
Seen in PSS with CREST syndrome