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Can ANA be negative but ENA positive in SLE? Confused

Hi
I have had unexplained PE 3 times now, joint pains, and pneumonia with pleural effusions three times in 12 months.  i have lichen sclerosis for the past 10 years and I am 28 years old.  I have always had bad, sensitive skin and have had anaemia and joint pain in the recent past.
I was tested for ANA and was negative but then was tested for ENA which came positive for Anti-Ro  but that was the only one found on ELISA.  The physician has little knowledge on this issue as he expected the ANA and other tests to be positive in a patient with SLE as it was not seen with other antibodies?  
I was also tested for lupus anticoagulant and that was equivocal.


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434278 tn?1324706225
Hi and welcome to Medhelp,

ENA test for several different things.  It test for antibodies to Smith, SSA, SSB, RNP, Jo-1 and Scl-70.  Yours was positive for the Anti-Ro (SSA).  30% of Lupus patients test positive for this antibody.  It is very posible to have a neg. ANA and still have Lupus.  Although SSA is also seen in people w/ Sjogren's (dry eyes, dry mouth, and arthritis)  SSA can increase sun sensitivity, and is associated w/ a skin disorder called sub-acute cutaneous lupus erythematosus.

If your dr. repeats the ANA, be sure and spend time in the sun prior to your next appointment.  If you have lupus, this will cause an immune response to occur, thus causing the ANA to be elevated.  Even if it is a cloudy day. (about 20-30 min.)
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Avatar universal
Thanks so much for the reply.
Funny you should mention the sun senstivity.  I live in Australia and normally the sun doesn't bother me at all.  This summer though I have found my skin is often more bothered by sunlight than it has in the past.  It almost feels like it is burning or stinging when sun touches it or I have been out in even the morning sun which it has never done before.  I also find I cannot go outside without my sunglasses on and even find fluorescent lights irritate my eyes.

I am seeing a rheumatologist this coming Monday.



Helpful - 0
434278 tn?1324706225
Sorry for the delay in responding.  I've got little boys in baseball, both at different fields...across town, of course.  Spring is very busy for us.

How did your dr. visit go?  Usually sun exposure causes symptoms to flare up.  If not that day, the next.  By symptoms, I mean joint pain, fatigue, diarrhea, muscle pain and weakness, ect.  It can also cause a malar rash too. (butterfly)  

I too have noticed my eyes super sensitive to not just sun light, but to indoor lighting as well.  
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Avatar universal
Hi.
You mention 3 pulmonary embolisms, I hope you have been tested for Antiphospolipid Syndrome. This is an auto-immune blood disorder, which can be ound in patients with Lupus , Sjorgens, and sometimes on its own.

I see you had the Lupus Anticoagulant done, but you should also have the Anticardiolipin Antibodies, done also.

This condition causes the blood to become sticky, and causes clots, are you taking anticoagulants?, it also causes joint pains, and for some who have Primary Antiphospolipid Syndrome, they describe it like a Lupus Like Disease.

Hope this has helped.

Nicola
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Avatar universal
I live in Australia as well :)

When I go out in the sun it takes about five minutes before I start to feel faint.  I immediately get a fever and my vision clouds over/blackens.  I feel nausea and feverish.  The second I am out of the sun I feel cold and feverish and horrible like I have a severe cold.  The longer my exposure to the sun, the worse my symptoms will be that evening and worse the following day.  It may even set off a severe flare... and if I get sunburnt then its all over :/
UV lights also do this to a smaller extent... interestingly, just before I was diagnosed in hospital after my PE and giving birth to my daughter, I was exposed to the theraputic UV lights they use on the jaundice babies in the premie department.  They caused my vision to immediately blacken completely and I was sure I would pass out.  I was in a wheel chair and went in and out of consciousness at times while exposed to that light.  I havent been exposed since, but it certainly was interesting.

I think a burning or stinging sensation is normal especially in australia, recently the sun has had an extra sting to it.
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Avatar universal
Your doctor may have ordered the ANA done by a multiplex method which may not include the ant-Ro antibody. I am betting that if he ordered the ANA done by the old classic IFE method, it would be positive. Unfortunately these days unless a doctor specifies in writing on the lab form that it be done by IFE, it will now default to the cheaper, less labor intensive multiplex testing, which only tests for a select few autoantibodies, rather than ALL of them.
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