ANA Patterns: Diagnoising Lupus and Related Connective Tissue Disorders

Antinuclear antibodies (ANA), which occur in a number of different autoimmune disorders including systemic lupus erythematosus (SLE) and Sjogren's syndrome, target specific protein antigens present in the body's nucleated cells. The preferred method of testing for ANA is the immunofluorescent (IFA) technique, which is considered the gold standard. Alternative methods such as the enzyme linked ELISA method are more likely to cause false positive results. Another benefit of the IFA ANA test is that the ANA detected in the IFA results yield distinctive staining patterns in the nucleus or cytoplasm of the reagent cells used to perform the test. These staining patterns offer specific clues as to which particular antinuclear antibody or antibodies may be present.

The specific autoantibody that's present, in turn, gives the physician information as to what autoimmune disease may be present or what other specific autoantibody tests need to be performed. In some cases, more than one autoimmune disease (overlap syndromes) may be present, which causes more than one ANA pattern to be present in a sample.

Some patterns are more specific for particular diseases than others. For example, in SLE, a homogeneous pattern is present, whereas a nucleolar pattern is seen in scleroderma and a centromere pattern in the CREST variant of scleroderma. The type of pattern determines what antibodies might be present. For instance, in a homogeneous pattern, anti-DNA antibodies are possible and this test would be recommended, whereas it would not be recommended in patients who have a speckled pattern ANA. The most common secondary antibody tests performed based on ANA results include: anti-DNA, anti-Sm, anti-RNP, SS-A and SS-B.

The homogeneous/rim ANA pattern can be caused by: antibodies to double and single-stranded DNA (seen in SLE in high titers and in lower titers in other rheumatic diseases),; and antibodies to histones (seen in drug-induced lupus), and deoxynucleoprotein (seen in SLE). A speckled pattern can be caused by the following antibodies: Smith (Sm), which is diagnostic of SLE; nuclear RNP, which is seen in high titers in mixed connective tissue disease (MCTD) and SLE; SS-A (Ro), which is seen in Sjogren's syndrome and SLE; and SS-B (La), which is seen in Sjogren's syndrome.

The centromere pattern of ANA is seen in the CREST variant of scleroderma, which will be described in an upcoming article. A nucleolar pattern is caused by the following antibodies/antigens: RNA polymerase I, which is highly prevalent in scleroderma; fibrillarin and also DNA topoisomerase I (Scl-70), which are both seen in scleroderma; and PM-scL, which is seen in polymyositis. An MSA pattern is caused by antibodies to mitotic spindle apparatus and NuMa; these antibodies can be seen in carpal tunnel syndrome, SLE, and Sjogren's syndrome; the cytoplasmic nucleolus pattern is seen in polymyositis.

While these patterns offer excellent diagnostic clues for autoimmune diseases, antinuclear antibodies may be negative during periods of low disease activity or remission. Because titers of these antibodies tend to rise during flares of disease activity, specific antibody tests as well as ANA titers can be used to measure the response to treatment and disease prognosis.

Resources: Marc Golightly and Candace Golightly, Laboratory Diagnosis of Autoimmune Disease, Medical Laboratory Observer, July 2002.

Elaine Moore, Autoimmune Diseases and Their Environmental Triggers, Jefferson, NC: McFarland Publishing, 2002.

Sep 5, 2008 11:05 PM

Guest :

I have all the symptoms of lupus and have lost 15 lbs. in past 2 months and am very weak/thin. Lupus specific tests show positive for ANAchoice(TM) screen, ANA pattern speckled, Antinuclear antibodies shows 1:16, and then two pages more of negative lab results for various lupus items. Does this mean I don't have lupus, or is it possible that I do have it?

Thank you for listening.
nvk

Sep 6, 2008 10:23 AM

Elaine Moore :

Hi NVK,
Yours is a fairly low titer. Most references state that a result lower than 1:80 like yours isn't significant. Your doctor could do more specific tests for instance tests for dsDNA antibodies, which are more specific for lupus. However, with a speckled pattern, it's unlikely that you'd have dsDNA antibodies. The ANA is a general test, which causes positive results in many different conditions. Low titers can also be seen in normal people. Even if your ANA result was negative, the results can't be used to confirm that you don't have lupus because sometimes positive results only show up during flares. Sudden weight loss isn't typical in lupus. It's more common in thyroid disease, another condition that can cause a slight ANA elevation. Best, elaine

Sep 18, 2008 8:02 PM

Guest :

Can you give insight on these lab readings? Went to Dr. complaining of weakness, fatigue, loss of muscle control and stiff joints. Symptoms are totally random and come and go every few weeks, months sometimes days but rarely. Have an appointment with a specialist but am digging for information as I have two children who need a competent mommy! Here they are.....Everything is normal except : Two tests shows ANA titer at 1:80 and speckled another shows it at 1:80 and homogeneous. Potassium level is a bit high at 5.9 and ALK-P is at 178. A breakdown of ALK-P shows the Bone at 64 and the Liver at 114. Thank you for your time and any advice....

Sep 18, 2008 8:18 PM

Elaine Moore :

Hi,
The ANA test is a general screening test and it can come up positive in a number of conditions and also in normal people. The Alkaline phosphatase enzyme elevation is only a slight elevation and the fractionation shows that it's due to liver instead of bone. If the other liver function tests were normal, it could be elevated from certain medications, including acetaminophen (Tylenol) or even estrogens. Your doctor will want to repeat the potassium test result. If the phlebotomist had any trouble drawing your blood this can cause potassium to be falsely elevated. It would also be good to have thyroid function tests as hypothyroidism can sometimes cause a positive ANA and a test for rheumatoid factor. Best, Elaine

Sep 19, 2008 12:50 PM

Guest :

I am a 54 year old women and have tested several times positive ANA for Lupus, arthritis, fibro, no one seems to know what is wrong with me just keep referring me to another doctor to go and see. My recent labs show C-Reactive Protein 1.8, ABS Basophils 0.07, ABS Monocytes 0.27 ANA Pattern Nucleolar and ANA Titer 1:40. I had a bone scan and it showed areas of increased uptake in each knee and foot and moderate uptake in low thoracic spine. I am in a lot of pain and always very tired it gets harder and hard for me to get up every morning and go to work. I have had about every test you can think of adn with every test I am told something different and passed along to another doctor. Hope you can help and tell me where I should go from here.

Sep 19, 2008 5:47 PM

Elaine Moore :

Hi,
Your best bet is to see a rheumatologist. Has the ANA titer ever been higher than 1:40? A level of 1:40 may not be significant. Monocytes are often elevated in recovery and basophils can be elevated in allergies. You could also ask for a test for scl70 antibodies. Best, Elaine

Sep 23, 2008 7:05 AM

Guest :

hi elaine,
my lab result for Rheumatoid Factor is <8.0 (can't remember the unit) and the lab personnel said it was ok, but my ANA test is positive with Speckled pattern, they also did anti DNA test for me and it was negative. i always have pain at joints part and it become worst during menstrual period. what does the lab result suggest?

Sep 23, 2008 9:40 AM

Elaine Moore :

Hi,
I'm not sure what units your lab is using but a < less than result usually means the level is too low to confirm that anything is there. Here's a link that describes the test further http://www.labtestsonline.org/understanding/analytes/ana/test.html
It explains that a speckled pattern can occur in several different conditions, but to diagnose any of these conditions you'd need further tests like ds DNA antibodies for lupus or an RF test to rheumatoid arthritis. With your results being low your doctor might want to wait to see if they rise. Best, Elaine

Sep 30, 2008 3:56 PM

Guest :

49 year old female no family history of Lupus
Blood tests ANA screen positive A
Ana Tither 1:640
ANA pattern Mixed spcekled and homogenous
Sed rate 23
no energy
Joint pain terrible
Hair loss
Dr has a suspicion of Lupus
I always thought there had to be a family history? Thanks bj

Oct 1, 2008 6:30 AM

Guest :

Hi.A 10 yr old boy has joint pain involving the small joints of hand and also wrists.On examination skin is shiny.ANA is positive in a titre of 1:80 and shows speckled pattern.What is the likely diagnosis?

Oct 1, 2008 10:40 AM

Elaine Moore :

Hi,
Your doctor will likely run other tests, both blood and imaging tests, depending on your son's symptoms. A titer of 1:80 can occur in people in the normal population especially if they have a history of an autoimmune connective tissue disorder. Some medications will also cause a positive ANA test, including several antibiotics. Best, Elaine

Oct 1, 2008 11:30 AM

Elaine Moore :

Your labs could indicate several different conditions, including both drug related lupus (autoimmunedisease.suite101.com/article.cfm/drug_related_arthritis) and systemic lupus erythematosus. Your doctor will probably run more tests like histone antibodies and ds-DNA antibodies to help with your diagnosis.
A family history of lupus isn't necessary for lupus to develop although many people with lupus have a family history of autoimmune disease, including thyroid disorders and rheumatoid arthritis. Best to you, elaine

Oct 3, 2008 1:38 PM

Guest :

Guest:
I have positive ANA w/RF,titer 1:320- Homogeneous and nucleolar pattern, I also tested positive 2x for Lupus anticoag,and Beta 2 glycoprotein IGM,anti DNA positive for single strand AB IGG,titer of 497.All other auto immune tests are negative. My last PTT test was normal. no positive test results for Double strand DNA. Iam also told by my neurologist that I had small strokes. No one seems to give me any answers as to whats going on. Can you help? Thanks-PJW

Oct 3, 2008 4:53 PM

Guest :

Suffering with joint pain and would like help with my blood test results. Positive Anachoice (TM) screen with a ANA pattern of speckled and a Antinuclear antiboides as l:160 high. Also Sjogren's antiboidy l.2 positive

Oct 5, 2008 10:22 AM

Guest :

Hi My SED rate is high. I have had morning stiffness for minimum of 2 yrs. It takes over an hr to start moving. Balance is bad at that time too. I've been treated for faciatis in both feet since June and P.T. Foot Dr. found SED rate high, sentme back to family DR. He's sending me to Rheumatoligist. All other boodwork is normal except for my sed rate.I'm tired of feeling this way. I'm 54, had always been active sister just diagnosed with RH, neice has fibromalagia,I hav had a lot of stress over last 4 yrs. weight has blown up because its difficult to move. I'm frustrated. sometimes I feel like I'm blown off by Dr.What do you think?
Pam

Oct 13, 2008 10:54 AM

Guest :

I have had arthritic pain (severe at times), fatigue (severe at times) sun sensitivity and Raynauds for some time now and my labs are as follows: ANA 1:32 homogeneous, positive DSDNA, red and white blood cells in the UA - the rheumatoligist repeated the labs and found the results are now within normal ranges - I am still having the symptoms but he says its not Lupus and he is not treating with anything but ibuprofen - what do you think?
Thank you, JL

Oct 21, 2008 10:45 AM

Guest :

You fail to mention the high degree of non-specificity with the ANA-IFA. There are over 100 antigens on HEP-2 cells that may reactive with antibodies in serum that are in no way associated with connective tissue disease. The defined population that is tested is critical to interpretation of any of these results, no matter what the method. EIA has a very high negative predictive value compared and a much higher specificity for CTD than IFA. The bottom line is that clinical diagnosis is extremely important when utilizing any ANA test. To often these tests are ordered without proper diagnosis and misleading results do occur more often than not, leading to more testing.

Oct 22, 2008 10:51 PM

Guest :

Hello! Thank you for reading and responding - I appreciate your help.

I have long had a list of symptoms, but it seems no one can put the picture together. Recently:
joint pain
skin rashes including on face and feet
painless sores on scalp and in mouth
unexplained fevers that come and go
fatigue

In the past, I had seizures (only two), and have had a range of little problems that have tended to come and go.

I have an ANA of 1:80 (speckled pattern), and ESR that rises and falls (highest over the last few times tests was 104. I've had a low-level thyroiditis, as well as pleurisy.

Any thoughts you can share will be appreciated.

Oct 23, 2008 3:53 PM

Guest :

I'm a 52 yoa male with severe arthryus. Recent ANA 1:320 speckled pattern Rh negative, and no family history. ANA test was reported as positive for Lupus. Other suggestions?

Oct 23, 2008 5:46 PM

Guest :

Hi, I have had 3 treatments for hep-c; first with alfa-interferon and ribavirin, unsuccessful, a couple of yrs later I had a trial of peg-interferon and cellcept, was virus free until 2 mos after stopping therapy, now aM 11 months out from the current fda standard therapy of peg-interferon and ribavirin , have been having intermittent bouts of severe fatigue , sleeping 1-2.5 days continusly during severe phases, remain virus free but now have come up with a pos ana titer of 1:80 ,speckled pattern, have been tested multi times in past always negative. cbc, lft's and renal studies all wnl, any opinion if this could be related to my treatment?

Oct 24, 2008 8:13 AM

Elaine Moore :

Hi,
Your speckled pattern could be associated with lupus but this test is positive in many other conditions, including drug-related lupus, which is caused by many different medications. You would first need to have tests for ds-DNA antibodies and the other antibodies used to diagnose lupus. If your RF test is positive you could have rheumatoid arthritis. Tests for HLA B27 are used to diagnose anklylosing spondylitis, which can also cause a positive ANA. You might want to read my articles on antibodies in lupus and also on connective tissue disorders to see what other possibilities there are. Best, Elaine

Oct 24, 2008 8:16 AM

Elaine Moore :

Hi,
Interferon and hepatitis C itself are both associated with the development of several different autoimmune diseases. Interferon is especially known to cause autoimmune thyroid disorders, and occasionally a low titer of ANA is seen in thyroid disorders. I'd definitely ask for thyroid function tests at your next appointment. I have two articles on autoimmune diseases associated with hepatitis on 101 that you should be able to find. Best, Elaine

Oct 24, 2008 11:44 AM

Elaine Moore :

Hi,
To poster with the sometimes 100 ANA.
I responded to two comments this morning so now I'm not sure if you're the gentleman with the arthritis or the person with hep C. Please clarify as this will help me get a better idea of what might be going on. Any other history, like rash, would be helpful too. Thanks, Elaine

Oct 24, 2008 3:14 PM

Guest :

My son is 16 yers old. He has been experiencing numbness and tingling with pain in his lower right leg for three weeks now - from the knee down. X-rays appear normal. Dr, says his ANA test is 1:160. He said he is not terribly concerned, that it "could be indicative of a connective tissue disease". His course of treatment is to have child take Advil, ice his knee and monitor pain levels.
What does this sound like to you? Ids lupus a likelyhood? What shoud I be asking the Dr.?

Oct 24, 2008 6:45 PM

Elaine Moore :

Hi,
Regarding your son, you might want to ask about running a test for rheumatoid factor, C-Reactive Protein, and for other tests that help differentiate the type of ANA that might be present, for instance tests for ds antibodies and HLA B27. If ice helps the inflammation go down, he might want to repeat the ANA as well. Best, Elaine

Oct 25, 2008 5:44 PM

Guest :

Hi. Thank you for responding to my question about my 16 year old son. His blood tests for rheumatoid factor and C-Reactive Protein were negative. What should I ask the Dr. about? His level of pain ranges from a 2 to an 8 on a scale of 1 to 10. He says it is mostly about a 7.
Thank you so much.

Oct 26, 2008 10:41 AM

Elaine Moore :

Hi,
Regarding your son, the negative RF and CRP are good signs and rule out active juvenile arthritis. Your doctor may be considering an injury or growth spurt and plan to repeat the ANA down the road. The ANA can be occasionally positive in the normal population. However, you might want to read up on the spondyloarthropathies http://autoimmunedisease.suite101.com/article.cfm/the_spondyloarthropathies and consider asking your doctor about them. If the pain is not responding to ice and anti-inflammatory tests, imaging tests, for an instance an MRI, might be a good idea. Best, Elaine

Oct 30, 2008 8:02 AM

Guest :

I am Carol - diagnosed with polymyositis 9 yrs ago and treated w/pred. For years I've been pretty much OK w/o the need for pred; my cpk even while "in remission" was higher than normal and jo1 a/bs present.
2 yrs ago carpal tunnel syndrome caused by arthritis/swelling. no longer an issue.
Now sick again. completely fatigued in summer then became depressed (had problems with depression on/off for 20yrs). I am extremely weak/fatigued/easily winded. I was sure I had a flare of PM.
I am 45 y.o female, 145 pds, 5'4", Meds: prozac, pamelor, adderall 10mg/day at most (helps with fatigue, psych prescribed), minocin 50 mg 3/week (just started). 10 mgs pred every 2 days. Lovaza (brought down my triglycerides quick, lowers my very high cholesterol (now 290)
New tests show:
CPK NORMAL? 110
JO-1 antibody is high (I knew that, says >8.0, POSITIVE(A) )

ANTI-NUCLEAR AB TITER 1:160
ANA PATTERN NUCLEOLAR A
Note on results says "A NUCLEOLAR PATTERN IS ASSOCIATED WITH SYSTEMIC SCLEROSIS" (my question: what's that mean?)
ANACHOICE SCREEN POSITIVE A

SJOGREN's AB(SS-A) >8.0 (H)
SJOGREN's AB (SS-B) <1.0 NEGATIVE

M.PNEUMONIAE AB(IGM),EIA 49 (IN RANGE)
M.PNEUMONIAE AB(IGG),EIA 2.30 (HIGH)
Note on results says a positive results indicate that patient has antibody to mycoplasma.

My RH Factor is <7, in Range.
SED RATE(ESR) 29(H)
CK 110 (IN RANGE)
Note from ME to you :) : that is SO strange. Does PM go away? Why am I feeling so weak/fatigued?

All reported Normal: Folate, B12, TSH (3.37), C-Reactive Protein, CPK, RPR, Lyme IgG and IgM, CCP IGG, HEP PANEL-ACUTE-W RFX, RF, PROTEIN ELECTRO-w/TP-SER, Immunofixation-Serum, Immunofixation-Urine, ANCA (just says < 6), SM/RNP AB RFLX TO SM

The *&#!! doctor forgot to do a CBC, but a month ago, I know that my white blood cell count was "high" but not dangerously, I remember my doctor said I probably have an infection somewhere.

Even before these tests I started looking into alternate therapies such as the low dose antibiotics.
PS FYI I had a cat scan of heart, no plaque. My score was 0.
Could my high cholesterol be due to deteriorating muscles?
I AM going to see my RHEUMATOLOGIST but he is away for 3 weeks. New doc for me- highly recommended, and prescribes the A/B therapy.

I know that my lungs are inflamed and I either have or almost have ILD (JO1 a/b).
Ongoing strange symptom since '99: knees and thighs swell on/off w/ flare

Oct 30, 2008 8:28 AM

Guest :

Oct 30, 2008 11:12 AM

Guest :

I am Carol - diagnosed with polymyositis 9 yrs ago and treated w/pred. For years I've been pretty much OK w/o the need for pred; my cpk even while "in remission" was higher than normal and jo1 a/bs present.
2 yrs ago carpal tunnel syndrome caused by arthritis/swelling. no longer an issue.
Now sick again. completely fatigued in summer then became depressed (had problems with depression on/off for 20yrs). I am extremely weak/fatigued/easily winded. I was sure I had a flare of PM.
I am 45 y.o female, 145 pds, 5'4", Meds: prozac, pamelor, adderall 10mg/day at most (helps with fatigue, psych prescribed), minocin 50 mg 3/week (just started). 10 mgs pred every 2 days. Lovaza (brought down my triglycerides quick, lowers my very high cholesterol (now 290)
New tests show:
CPK NORMAL? 110
JO-1 antibody is high (I knew that, says >8.0, POSITIVE(A) )
ANTI-NUCLEAR AB TITER 1:160
ANA PATTERN NUCLEOLAR A
Note on results says "A NUCLEOLAR PATTERN IS ASSOCIATED WITH SYSTEMIC SCLEROSIS" (my question: what's that mean?)
ANACHOICE SCREEN POSITIVE A
SJOGREN's AB(SS-A) >8.0 (H)
SJOGREN's AB (SS-B) <1.0 NEGATIVE
M.PNEUMONIAE AB(IGM),EIA 49 (IN RANGE)
M.PNEUMONIAE AB(IGG),EIA 2.30 (HIGH)
Note on results says a positive results indicate that patient has antibody to mycoplasma.
My RH Factor is <7, in Range.
SED RATE(ESR) 29(H)
CK 110 (IN RANGE)
Note from ME to you :) : that is SO strange. Does PM go away? Why am I feeling so weak/fatigued?
All reported Normal: Folate, B12, TSH (3.37), C-Reactive Protein, CPK, RPR, Lyme IgG and IgM, CCP IGG, HEP PANEL-ACUTE-W RFX, RF, PROTEIN ELECTRO-w/TP-SER, Immunofixation-Serum, Immunofixation-Urine, ANCA (just says < 6), SM/RNP AB RFLX TO SM
The *&#!! doctor forgot to do a CBC, but a month ago, I know that my white blood cell count was "high" but not dangerously, I remember my doctor said I probably have an infection somewhere.
Even before these tests I started looking into alternate therapies such as the low dose antibiotics.
PS FYI I had a cat scan of heart, no plaque. My score was 0.
Could my high cholesterol be due to deteriorating muscles?
I AM going to see my RHEUMATOLOGIST but he is away for 3 weeks. New doc for me- highly recommended, and prescribes the A/B therapy.
I know that my lungs are inflamed and I either have or almost have ILD (JO1 a/b).
Ongoing strange symptom since '99: knees and thighs swell on/off w/ flare

Nov 1, 2008 4:09 PM

Rebecca Pierson :

I was diagnosed with osteoarthritis a couple of years ago but I don't think that is all that is going on with me. About once a month I feel so exhausted and achy I don't even want to move and I can't blame that on having periods because I had a hysterectomy. I have constant joint pain and migraines and after my hands started swelling I had blood tests run. My sed rate was 42, positive anachoice screen with a nucleolar patter and the antibodies were 1:160. I met with a rheumatologist after this because now my ankles hurt really bad when I try to walk. He did no blood test before he decided that I didn't have arthritis and that those tests I had done were worthless because he doesn't do them. He decided to test me for Vitamin D defincency and Hep C which I told him that I don't live the lifestyle for Hep C meaning I'm not doing drugs or have sexual partners other than my husband of almost 14 years. I do have a Vitamin D defincency which I am taking the vitamin to correct. The original doctor that ran these tests wasn't sure what to do but basically told me that I had a connective tissue disease but he didn't know which one. I live with exhaustion and am tired of it. Further testing ruled out rhuematoid arthritis, lupus and sjogren's. Any help that you can provide I would apprecitate.

Nov 6, 2008 5:04 PM

Guest :

My name is Elizabeth and I just recently had some bloodwork done since I have been having problems with joint pain and swelling. The ANA test came back positive with it being > 1:640 with both a speckled and homogeneous pattern being detected . Also I had a positive result on Antistreptolysin o titer with a result of 621 ( abn : h ) What should my next step be?

Thanks

Nov 6, 2008 6:38 PM

Guest :

I am a 53-year-old female who just recently had a skin reaction around the outer part of my eyes that was red,severe dryness and wrinkling. M.D.tested found ANAchoice screen positive ANA titer 1:640;pattern SSA/ro;additional testing revealed sjogren AB (SS-B) 2.8 positive;sjogren AB(SS-A)8.0 positive; lupus antibodies still pending and sed rate pending. What do you think. I am asymptomatic without joint pain,very active with occasional fatigue at night otherwise no other symptoms. I am waiting for results before seeing rheumatologist. My initial ferritin was high 289; hepatic function panel total protein high 8.8 and globulin 4.3 high. What do you think about all of this? I also suffer from severe dry eyes for past three years but thought it was from menopause and prolonged contact lense use and occasional dry mouth last few months. DF

Nov 6, 2008 7:14 PM

Elaine Moore :

Hi DF,
Your labs and symptoms point towards Sjogrens syndrome. There are several subtypes of Sjogrens.
see my article on sjogrens subtypes
Your doctor may want to run more tests to help diagnose your condition.
Best, Elaine

Nov 6, 2008 7:21 PM

Elaine Moore :

Hi Elizabeth,
Here's a link that explains the ASO test. http://labtestsonline.org/understanding/analytes/aso/test.html
Have you had a recent strep infection?
Your doctor will probably order more tests such as the DS DNA to help diagnose your conditions.
This article rheumatism.suite101.com/article.cfm/autoantibodies_in_systemic_lupus
explains some of the other tests used for diagnosis. Best, Elaine

Nov 6, 2008 7:23 PM

Elaine Moore :

Carol,
It looks like my reply never showed up.
Systemic sclerosis is another term for scleroderma. There are a few articles on scleroderma on this website. Best, Elaine

Nov 10, 2008 8:57 PM

Guest :

I went to the doctors because I was breaking out in hives when ever I went out into the sun. They ran a tissue disease cascade 2. All came back negative but They also ran a ana test that came back positive the ana units are 9.59 When I read about the levels or units on different web sights I'm seeing way lower numbers my doctor is sending me to a rumotologist but what do these out of this world high numbers mean? 9.59?

Nov 11, 2008 9:53 AM

Elaine Moore :

Hi,
In most ANA tests, positive results are reported as a titer. This means the blood is diluted and the highest dilution in which results are still positive is reported as a ratio like 1:80. You'll have to ask for the reference range for the specific test you had done. Then, you'd need to compare your result to this reference range. Best, Elaine

Nov 11, 2008 1:14 PM

Guest :

I have had the following symptons - started just being thirsty, followed about a month later of also frequent urination caused by drinking because I was thirsty although I can only get 4 hours of sleep before having to get up to urinate and have hard time getting back to sleep. Had tests for diabetes come back as being normal so ANA Titer done and came back as Speckled 1:160 - doctor says that is still considered negative but if I want to go to rheumatiod (sp) he will give me referral - is it worth my money to check this out?

Dec 3, 2008 1:39 PM

Guest :

Hi,
My 15-year-old daughter recently had a blood test and her ANA(CHoice) is positive, creatine kinase is 164, ANA IFA is positive and reflex ANA pattern 1 is homogenous with a titer 1 at 1:640. She has all over muscle pain especially when cold, fatigue, joints hurt, etc. She does have oshenschlager(sp?) disease in her knees, too. What do you think all of this is indicative of? Lupus or fibromyalgia?
Thanks,
Concerned mom

Dec 14, 2008 7:02 PM

Guest :

Hi there,
I'm a 44-yr-old female, persistent digestive problems for 10 years. Recently diagnosed with h.pylori (on second round of treatment as first failed). Recent blood tests show likelihoon of CREST.
ANA = OR >1:640, Centromere pattern
ALT 78
Red blood cell count 5.20
ESR 83
Protein 0.3
eGFR 67
RF 34

GP is amazed that I have little/no joint pain. Waiting for appt. with rheumatologist. While I do understand the significance of the centromere pattern, I'm still wondering if h. pylori could be producing some test results, or if I've had the bacteria for a decade or more, whether it could cause other problems that could result in these numbers. Trying to do a little research before I see the rheumatologist so I'll know specifically what I want to ask.

Thanks in advance for your help!
Lynne

Dec 15, 2008 2:11 PM

Elaine Moore :

Hi,
I haven't seen anything specific saying that H.pylori interferes with the ANA test results. But not everything has been studied when it comes to interferences. Let us know if you find anything concrete on this. I'll also check some references at work this week. Best, Elaine

Dec 22, 2008 7:47 PM

Guest :

Hi I am having alot of problems. need some help in feb. of this year i was having some pain in my wrist my mom has RA so i was tested for it (NEG)but they also did the ANA it came back (POS speckled 1:80). with my wbc13.2H then in aug. i had some test done and these were the results CA-11.2H TP-8.5H WBC-13.2H RBC-5.16H HGB-15-8H LYMPH-4.9H MONO-1.11H VIT.B-12 DEFICIENCY then later in aug. wbc-12.10H then in nov. wbc-11.5H absolute lymphocytes-4152H alt-44H then dec,5 albumin-5.1H wbc-18.30H neutro ab-11.3H lymphs abso-5.5H monos abso-1.1H mean cell hb-32.7H then dec,16 wbc-12.4H absolute monocytes-1042H sed rate-8 ana w/refl to titer this one was (neg) they told me i most likely had lupus but now they dont think so. i have an apt with an (oncolagist) sorry if i spelled that wrong. now they think it could be leukemia i have alot of crazy stuff going on. i am always very tired even after my bi-weekly b-12 shot, tongue and roof of mouth sore, ringing in my ears, pain all over, and now my arms get weak and when that happens i will get hand tremors. im scared im only 30 with 3 small children please help.
Walk by Faith and Grace
Michelle

Dec 22, 2008 7:53 PM

Guest :

Dec 26, 2008 10:38 AM

Guest :

Guest:
I have severe joint pain in my knees and hip joints and i am a thin 20 yr old. I have a positive ana screen,a speckled ana pattern and my titer level is 1:80. My doctor says i do not have lupus but I cannot figure the reason for the ana results otherwise, does anyone have any ideas as to what is wrong?

Dec 26, 2008 9:48 PM

Elaine Moore :

Hi Michelle,
Your doctor will want to run more tests before diagnosing your condition. Wrist pain can be associated with many things including fractures and tendonitis. The elevated calcium should be confirmed with a test for ionized calcium. Tests for parathyroid hormone are usually done when calcium is elevated. I'm not sure why leukemia was mentioned but a bone marrow aspiration would be needed to confirm this condition if it were truly suspected. Best to you, Elaine

Dec 27, 2008 1:10 AM

Guest :

Hi,
I am a 36 year old mother of two. After my first child i was told I had a positive ANA result indicating a possible connective tissue disorder however after seeing an specialist, he said it wasn't that significant but that I needed to keep an eye and gave me a shot of cortisone to improve the pain in my joins, unfortunatelly the shot didn't work and it made my pain worse for a few days. The pain and stifness improved while I got pregnant with my second child but 10 months later after giving birth the pain is back and a bit more painful, making getting up of bed very painful as well staying in one position for too long. I saw the doctor and requested an ANA test. The result are a bit unclear to me. It reads,
ANA: Detected: Mixed pattern.
Titre, Pattern 320 Speckled
320 Homogeneous.
Coments
(Screened at a titre of 80)
A moderate or high titre mised pattern ANA may indicate the presence of antibodies to nuclear antigens of multiple specifities. Characterisation of these specifities by ENA testing as well as dsDNA and chromatin may be useful. changes in the specificities may occur with evolution of connective tissue disorders as well as chnges in disease activity

Does it mean ratio 3:20? Does it mean I may have Lupus?
I was also tested for thyroid Function TSH was 0.91 mUL and my C reactive protein was 0.6 mgL. I was also tested for Iron and a full blood count withi was withing rerence limits. Can you explain the above to me in plain English? Many thanks.

LM
A worried mum

Dec 30, 2008 5:20 PM

Guest :

i had a full blood panel done my ana was the only positive specled 1:80 i go to a dermatologist in jan are these 2 diseases my only chances of diagnosis?

Dec 31, 2008 5:36 PM

Elaine Moore :

Hi,
A low titer like 1:80 can occur in people with no evidence of autoimmune disease. It can also occur in thyroid disease and other conditions. For a diagnosis of lupus or connective tissue disease, your doctor would need to see certain signs and other positive test results. Best, Elaine

Jan 9, 2009 12:43 PM

Guest :

My 2 year old daughter has been back and forth between many doctors. She has very numerous swollen lymphnods and goes through spells of weight loss, sporadic vomiting and is very fatigued during these spells. She has also been prone to sporadic fevers and night sweats on a regular basis. Many doctors tell me I can fell her lymphnods because she is so small. I do not buy this, she has always been small and they have grown in numbers and size since this first started. My concern now is that she tested positive on the ANA with a 1:40 speckled. Could this have anything to do with evverything else going on?
Clueless in NC

Jan 9, 2009 8:59 PM

Elaine Moore :

Hi,

A titer of 1:40 isn't usually significant. If your doctors thinks it might be related to her symptoms, he'll order more tests. Has she had her thyroid function tests checked? Best, Elaine

Jan 13, 2009 6:19 PM

Guest :

Hi Elaine,

I've been feeling tired and achy for months now, with horrible intermittent pain in my shoulders, hips, and TMJ especially. My eyes are constantly red and irritated, and I often have a burning aching pain in my neck and in my side abdomen above my hips. My stress levels are through the roof. I often have emotional outbursts, fits of crying and a loud noise makes me jump through my skin.

Recently had blood work done and my ANA screen came back positive, with a titer of 1:160, homogeneous pattern. My Rheumatoid factor is 8. My White Blood Cell count showed as low (3600) with neutrophils(59.5%) lymphocytes(33.3%) monocytes(5.9%) eosinophils(1.0) and basophils(0.3). My Vitamin B12 was 576 (low end) and my magnesium serum was 2.0 (low as well?).

Please help. My GP doesn't handle these types of things, and I'm being referred onto a specialist, but he can't fit me in for a month. What can I be doing? Is there anything I should avoid eating? Should I avoid alcohol? Sugar? I'm still breastfeeding my 18 month old daughter. Should I wean her? Can the ANA's be transmitted through breast milk? I would really appreciate your help.

Sincerely,
CASR

Jan 14, 2009 8:40 AM

Guest :

Jan 14, 2009 5:04 PM

Guest :

Jan 15, 2009 7:38 AM

Guest :

Jan 15, 2009 8:40 AM

Guest :

Hi, I'm a 30 year old African American female who has a ANACHOICE (TM) screen "positive", ANA titer and pattern ANA, IFA titer of "1.320 (negative)", an ANA pattern "speckled", RF "6", DNA AB (DS) Crithidia, IFA "negative"; ENA, SCL 70, SS A, SS B SM antibody "<1.0 neg", SM/RNP antibody "<1.0 neg"; Sjogren's SSA & SSB "<1.0 neg", SCL-70 "<1.0 neg". CMP within normal limits (no out of ranges), HIV "negative". What should I do next and what does this mean? Thank you in advance. THR

Jan 15, 2009 9:33 AM

Guest :

Hi - After one blood test with a 1:160 speckled pattern, my doctor ordered more tests and a repeat of the ANA. My second blood test showed a 1:320 speckled ANA pattern, negative SS-A and SS-B, and a positive ds-DNA of 25. My doctor says it looks like lupus, but that I'll need to see a rheumatologist for a definite diagnosis. I'm waiting on a referral to rheumatology, and trying to read as much as possible in the meantime. Your site is very helpful!

What I am wondering is, is a ds-DNA of 25 considered to be in the low, mid, or high range of positive results?

-AL

Jan 15, 2009 3:15 PM

Elaine Moore :

Hi,
It sounds like your doctor has run most of the confirmatory tests available to help with your diagnosis, but a specific pattern doesn't seem to be emerging. You might want to read the articles I have on mixed connective tissue disorders and undifferentiated mixed connective tissue disorders. Your CMP results in the normal range suggest that there are no kidney or liver abnormalities. Depending on your symptoms, your doctor may want to order more tests or treat your symptoms. Best to you, Elaine

Jan 15, 2009 3:30 PM

Elaine Moore :

Hi,
A 25 for the dsDNA is usually a slight elevation but you'll need to look at the reference or normal range provided by the laboratory that ran the test. It's usually listed beneath your results. Like if the reference range is <20, a result of 25 would be only a slight elevation. Best, Elaine

Jan 15, 2009 4:00 PM

Elaine Moore :

Hi,
ANA are a type of antibody that targets the nucleus of certain cells. I haven't heard of ANA being transferred through breast milk.
ANA sometimes show up for no specific reason. Your magnesium level looks fine according to the usual ranges.
You might look at the articles I have on dietary and lifestyle changes for lupus as these tips are helpful for most of the autoimmune disorders including arthritis. The life extension website, www.lef.org also has some helpful information. You may not have a rheumatological disorder, but these tips are all good for general health. Best to you, Elaine

Jan 18, 2009 5:04 PM

Guest :

I have been sick for 5 1/2 years. Many, many symptoms plus some signs. Some occur for days, some for months and some are always present. To name a few - 25 lb weight loss, difficulty swallowing, weakness down specific paths but normal overall strength, severe eye pain with light,very dry mouth to the point where I haev to drink water to talk, muscle twitches in dozens of areas in my body sometimes hundreds of times per day, word loss, leaving money behind in ATM, double vision, blurry vision, extremely thirsty, feeling very overheated in torso and head for months or days, fluorescent lights feel as though they burn a hole in my head, plus more. Relative to tests I have had a positive ANA since the beginning, no one has ever told me the titre even though I asked. The pattern was mixed: speckled and homogenous for at least the first 8-12 months and then at some point after changed to be just Homogenous. In the first few months I had an elevated CRP and ESR that was declining with each test until it became normal with very low results (non detectable and approx. 5-7 respsectively). I had very little tests for it after the first few months but in the infrequent testing (approx. yearly) done I was always in that same range until July/2008 when my ESR was 24 and CRP 4.8 (acceptable range but increased from prior tests). The next test showed 17 and ND. Done again two days ago and I am now at 32 and 4 so again slightly elevated and acceptable range but elevated for me.
I have also had increased neutrophils occasionally plus July and August tests showed increased WBC. I have had negative RF, negative x-rays, normal anti ds-dna, and supposedly other tests were normal. What are your comments?

Jan 18, 2009 7:34 PM

Elaine Moore :

Hi,
Sorry to hear you're not feeling well. Please read the article I wrote on Sjogren's subtypes
autoimmunedisease.suite101.com/article.cfm/sjogrenssubtypes
If this sounds like a fit, ask your doctor about it and about running some of the other tests to help diagnose it. Best, Elaine

Jan 18, 2009 9:13 PM

Guest :

Hoping to get a little light shed here...
For the past 8-9 years I have been suffering from severe muscle/joint pain and severe fatigue. Recently, in the last 4 years, I have had several tests done to find out whats going on. My RA test came back negative, my ESR was 2, Lyme's titer was 0.32, TSH was listed only as High Positive, celiac test was negative. I have a family history of autoimmune disorders (hypothyroidism and RA)so my GP also ran an ANA screen and the results of that were H positive with a titer of 1:64. Because of those results she suspected Lupus and referred me to a rheumatologist. I spent about 10 minutes with him total, he pushed on the trigger points for Fibro and because all but 2 locations were positive, he said it was "just Fibro", gave me a Rx for a muscle relaxer, and scheduled PT. Since that time I have developed several other symptoms including hair loss, rashes, bowel issues, kidney infections, protein in my UA, severe fatigue, muscle and joint pain so bad that I can hardly perform even the most simple of activities of daily living, weight gain, temporary right-sided facial and arm paralysis, pain/weakness, and the list goes on to a total of 25 different symptoms. We have tried muscle relaxers, pain meds, Lyrica and nothing seems to even touch my symptoms. At 34 I know this is not normal. I am wondering if the original Dx of Fibro was wrong, and if the rheumatologist even looked at my tests. I am scheduled in about 2 months to see a different rheumatologist, but am wondering what things I should be asking as far as tests, diagnosis, and treatment? Any help you can offer me would be greatly appreciated!
Barely hanging on....Niki B

Jan 19, 2009 8:10 AM

Elaine Moore :

Hi Niki,
The first clue here is your high TSH result. In general, results higher than 3.0 mu/L suggest hypothyroidism. TSH is a pituitary hormone that helps regulate thyroid hormone levels. When your actual thyroid hormone levels, FT4 and FT3, fall too low the pituitary tries to help out by secreting more TSH. TSH orders thyroid cells to produce more hormone, but when hypothyroidism develops TSH can't do it alone. That's when thyroid replacement hormone is needed.
Ask to have a copy of the original report faxed or mailed to you. There should be a value listed with High Positive listed as a flag unless this was some qualitative screening test. If this is the case, the physician who ordered the test should have followed up with a regular TSH, FT4, and FT3 test and also tests for thyroid antibodies.
The ANA can be positive especially at a low titer like 1:64 in hypothyroidism. Hypothyroidism causes joint pain and it can cause symptoms similar to those seen in fibromyalgia. You might want to check with the original ordering physician to ask about follow-up tests and perhaps a referral to an endocrinlogist.
You might want to check the articles I have here on subclinical hypothyroidism and autoimmune thyroid disorders. Best, Elaine

Jan 20, 2009 12:25 PM

Elaine Moore :

Hi,
re: Ball's palsy, drawn face, and positive ANA with anemia, eye not closing. Is your eye bulging with proptosis causing it not to close? Possibilities would be thyroid eye disease (Graves' ophthalmopathy), myasthenia gravis and other disorders. Bell's palsy can occur for no reason and it occurs in many disorders including Lyme disease.
Your doctor can run more specific tests to see what's causing the positive ANA. Usually, a high titer occurs in rheumatological disorders and some of these like Sjogren's can have affect multiple bodily symptoms. I think more tests are needed for a better idea of what's going on here. Let us know what you find out. Best, Elaine

Jan 21, 2009 2:04 PM

Guest :

HI
I am a 30yr old, with a strong family history of RA on my mothers side and my mother also had scleroderma. I have a DVT of my rt transverse sinus, my crp, sed rate, thrombo panel, and cbc were normal. However my ANA was 1:640. I have no symptons other than my right knee aching. I have an appt with a Rheumatologist in 3 weeks however that seems like forever. Do you have any idea if this could be either of the above or elevated because of my strong family hx????

Jan 21, 2009 6:27 PM

Guest :

I saw my dr. back in Dec. and was DXd with Raynaud's and migraine variant. I get facial flushing with the headaches along with confusion and memory loss, and lots of pain with the cold. My dr. ordered workup for lupus. My sed rate was elevated and ANA positive, Rh negative. At Jan. visit, he ordered ANA panel/CBC/CMP. (CBC platelets elevated, MPV low, RDW low. CMP Anion gap low. Just incase anything stands out as a flag) ANA positive 1:320 homogeneous with speckled also detected. The only bone/joint pain I have is tailbone pain for which I get injections, and my hands(presumably from working as a transcriptionist). I do have extreme sensitivity to UV(tanning beds) and get a thick rash every spring on my arms and legs. I also get occasional ulcers in my nose. I have never considered the possibility of lupus because I get symptoms so sporadically and deal with them one at a time. Is it likely that I may have lupus with so little bone/joint pain? If so, is there any significance to the "homogenous with speckled pattern detected" as far as diagnosis?

Thank you,
TLS

Jan 21, 2009 6:28 PM

Guest :

Jan 21, 2009 8:15 PM

Elaine Moore :

Hi,
Studies show that immediate family members of people with autoimmune diseases can have positive autoantibody tests but no other signs of an autoimmune disease. It's a good idea to see a rheumatologist. He or she can run other tests and see if you have evidence of a connective tissue disorder. The ANA test is usually positive in connective tissue disorders, including RA and scleroderma. We generally inherit a predisposition that makes us susceptible to developing autoimmune disorders but not one specific autoimmune disorder. Other connective tissue disorders include Sjogren's syndrome, ankylosing spondylitis, mixed connective tissue disease, systemic lupus erythematosus and mixed connective tissue disease. People on certain medications can also develop a drug-induced form of lupus that causes a positive ANA titer and joint pain, which resolves when the offending medication is stopped. Best, Elaine

Jan 21, 2009 9:46 PM

Elaine Moore :

Hi,
people with Raynaud's can have a positive ANA with a speckled pattern. The range for platelets is usually 160--375. If your platelet count is only slightly higher than 375, it may not be significant. Your doctor will probably repeat the test if the result is moderately elevated. The other CBC parameters aren't significant.
There are several criteria for diagnosing lupus, and it wouldn;t be diagnosed with a sole elevated ANA result. Your doctor will probably run more tests to rule out lupus. He or she can't really say that the positive ANA is from Raynaud's without ruling out other conditions. Best, Elaine

Jan 25, 2009 4:53 PM

Guest :

Hello,

I have been struggling many different symptoms. I just had seen my neruologist and had another round of blood work done. My ana came back 1:640. I have been running that that for almost a year right now. I am back to my normal of being tired and sleeping alot. He told me that my dna test was negative. I am pretty confused right now. I don't see my rheumatologist till next month. I so signs of lupus but I am just not sure what to believe anymore. I am so sick of being sick. I am not sure what my titer was from this last round of blood work. I just had another ASO test done on Saturday because 6 months ago my levels were 9 times the normal limit. He said I had the step infection in my system which is crazy because I don't remember ever having strep. So that was pretty weird. I really don't know what to think. My neurologist said that he was pretty sure that is was Lupus that I have. I am just pretty confused. I just want to feel 100% again. Thanks for any information that is given.
Symptoms:
very tired, sore muscles, lost about 12 pounds in about 4 weeks. Water retentions. facial rash that comes and goes.

Thank you

Jan 26, 2009 6:58 AM

Elaine Moore :

Hi,(Re:high ASO)

As far as laboratory test interpretation goes it sounds as though there's a post infectious process going on, perhaps septic arthritis or one of the conditions mentioned in these links:
http://www.clinlabnavigator.com/Tests/AntistreptolysinO.html
http://labtestsonline.org/understanding/analytes/aso/sample.html
In the second link be sure to look at the second link regarding post-infectious sequelae. You'll see from the first link that pharyngeal strep infection may go unnoticed, which is why you may not remember symptoms.
Studies also show that sometimes an unresolved infection can cause a septic arthritis that stays pretty much dormant, but could account for a positive ANA. Later, if there's any exposure to the infectious agent, the latent infection causes the sequelae mentioned. Let us know what your eventual diagnosis is. In lupus, the ds-DNA antibody test is usually positive. Best, Elaine

Jan 27, 2009 6:35 PM

Guest :

Hi,
I have been trying to conceive for about 6 months with no success. I am a 31 year old female who, about 8 years ago, was on the drug Minocin for acne. Upon taking the drug I developed symptoms similar to Lupus - joint pain, rash, positive ANA. I have had tests done for Lupus and other autoimmune disease, all of which came out negative. (I no longer have symptoms). However, 8 years later I still have a significant positive ANA. Is this affecting my chances of conceiving or to be able to carry a baby to term? Is there anything I can do about the positive ANA? I have read about people with positive ANA having an increase in miscarriages or not being able to get pregnant at all - is this true? Does the positive ANA have to be connected with a specific autoimmune disease in order for the complications with pregnancy to occur or are all individuals with a significant positive ANA considered high risk during pregnancy?

Thank you so much,
A.N.

Jan 28, 2009 10:54 AM

Elaine Moore :

Hi,
Minocycline is known to cause drug related lupus, and it sounds like that's what you had. See autoimmunedisease.suite101.com/article.cfm/drug_related_lupus
With DRL, the ANA can stay positive for a long time. Ask your doctor if he or she thinks this is the cause of your positive ANA. Otherwise, ANA is positive in connective tissue disorders and isn't associated with infertility.
There are other autoimmune causes of infertility. See
autoimmunedisease.suite101.com/article.cfm/autoimmuneinfertility

You might want to see if anything in this article sounds familiar. I also recently read that gluten sensitivity is a common cause of infertility. In gluten sensitivity and also celiac disease, people react immunologically to the gluten protein in wheat, barley and rye. This condition affects 1 in every 133 people especially people of Northern European descent. I have it and wasn't diagnosed or didn't develop it until my 30's. Symptoms vary so it's often not detected or looked for right off. It too is something to consider. Best, elaine

Jan 28, 2009 1:39 PM

Guest :

Hello,

I wrote the other day, I found out that my ASO test came back still high but going down for the Strep B. I told my rheumatologist that my neurologist had tested my blood about 6 weeks ago and my ana came back postive and that he wanted to talk to them so that they could get things worked out for me. I am going to be going in to a seziure center in about 2 months. With an auto immune disease is that common to have vertigo or is there more that I should be asking more of my doctors. I am to the point I am ready to pull my hair out. I just feel like I am going around in circles and I am just lost and I don't know what to do anymore.
Thank you

Jan 28, 2009 2:35 PM

Elaine Moore :

Hi,
there are more than 80 different autoimmune disorders, all with a wide range of symptoms. Most people with an autoimmune disorder have a few predominant symptoms, and these symptoms can change over time, and they can also vary in severity. Vertigo can occur in various disorders, and it can also occur in Meniere's, which some people consider an autoimmune disorder. Let us know what your doctors decide on. Best to you, Elaine

Jan 29, 2009 2:16 PM

Elaine Moore :

Dear KMK,

I'm sorry to hear that you haven't been well, and I'm glad you have a doctor who is helping you to get a proper diagnosis and treatment. Your ANA titers aren't very high although the fact that both tests showed a nucleolar pattern warrants further investigation. Your blood tests for BUN and liver enzymes are on the high end but not significant. Could your GFR result been <60 rather than >60? A greater than 60 result (>60) is normal. See this link for more information on this test.
Your doctor will probably need to run a few more tests to tell what's going on. I hope you feel better soon. Elaine

Jan 29, 2009 10:12 PM

Guest :

My ANA titer is high, at 1:640, ANA pattern nucleolar. Is this likely indicative of scleroderma? She has now had drawn complement C4 and complement C3, anti-DNA AB, anti-SSA AB, Anti-SSB AB, anti-scleroderma (SCL-70) AB, anti-Smith/RNP AB. My main symptoms are unremitting fatigue and IBS. As labs will take a couple of weeks (?), just wondering how concerned I should be. Thank you for your help.

Jan 29, 2009 10:30 PM

Elaine Moore :

Hi,
The nucleolar pattern can be caused by several different antigens/antibodies.
From the article:
A nucleolar pattern is caused by the following antibodies/antigens: RNA polymerase I, which is highly prevalent in scleroderma; fibrillarin and also DNA topoisomerase I (Scl-70), which are both seen in scleroderma; and PM-scL, which is seen in polymyositis. An MSA pattern is caused by antibodies to mitotic spindle apparatus and NuMa; these antibodies can be seen in carpal tunnel syndrome, SLE, and Sjogren's syndrome; the cytoplasmic nucleolus pattern is seen in polymyositis.

So any of these diseases mentioned can cause a positive nucleolar pattern; also, it's not unusual for the ANA to be positive without a clear pattern of any specific disease showing up. Recently, there have been reports of gluten sensitivity (affecting 1 in 133 persons) causing a positive ANA and often being misdiagnosed as IBS. This would be another condition worth following up on. Best to you, Elaine

Feb 2, 2009 10:37 AM

Guest :

My name is Judy. My daughter Kymberly 19 (of whom I have written permission to discuss her condition) has Hashimoto's Thyroiditis. As a very young child, I noticed what I thought was a goiter (now gone). Because at the time I had an elevated tsh the pediatrician humored me and tested her thyroid. Her level at that time was elevated, but subsequently returned to normal. That is Up until December 08. Her latest TSH = 4.11 (not bad, but slightly out of the laboratory's normal range) (fyi:I do not have the antibody and am now euthyroid)
The problem: Kymberly has been throwing up for more than 2 years. Certain foods (fatty foods and milk) seem to make it worse, because her GI doctor did not find a smoking gun. From A GI perspective, the nuclear gastric emptying time, GI swallow study, upper GI, EGD along with it's biopsy's were all negative. He referred her to a allergist, (Kymberly also has multiple allergies) This Allergist felt her slightly low complement (CH50 = 156) and her past medical history of toxic shock symdrome w/dic,low wbc etc was a bit out of his scope of practice and she referred us on to National Jewish.
Recent Testing did produce a positive Prometheus IBS/ Chrones result. Tests also showed a positive anti neutrophil cytoplasmic Antibody; specifically pos cytoplasmic ab,and neg perinuclear AB. (This is different from a test done in 2004 where the cytoplasmic ab was neg and perinuclear ab was pos) Her ANA pattern is speckeled with a titer 1:80 (Kymberly has always had a relatively low wbc; with normal ANC. Except when in 2003 she had toxic shock symdrome. Then her WBC only made it as high as 7.7 with a shift to the left. (with blood cultures coming back ragingly positive in 12 hours.)
Have you ever seen Hashimoto's cause chronic vomiting? Could they be linked? If so, Can it be treated?
Kymberly has an appointment with an endocrinologist here in in town on March 9th. In your opinion, should she be started on Levothyroxine before the appt?
Thank you for your help.

Feb 2, 2009 11:30 AM

Elaine Moore :

Hi,
I'm sorry to hear Kymberly is having troubles. With an ANA titer of 1:80, the results could be false positive or testing positive for no apparent reason. Because of the nausea and vomiting, gluten sensitivity immediately comes to mind...mostly because these were the symptoms that plagued me for years until I was tested. Gluten sensitivity has a number of variants and in some variants only the test for gliadin IgG comes up positive. I might add that I don't have a wheat allergy although, like your daughter, I'm allergic to many foods (lettuce, corn, soy, melon, tomatoes, etc) but I am sensitive and react to gluten, the protein in wheat, rye and barley. Similar symptoms can occur in people similar to wheat products. Dr. Mercola has a lot of information on grains on his website, and there are several good books out on gluten sensitivity, including the gluten connection by dr. shari lieberman.
National Jewish has a marvelous immunology lab and excellent diagnosticians. I'll be curious to hear what they have to say. And I'd hold off on Synthroid until although the tests are completed. Best, Elaine

Feb 4, 2009 6:00 AM

Guest :

I am 30 year old mum of two. I did arhritis profile test because of pain in legs.Pain is the worst during menstruation,mostly in knees and left hip. ANA is 1:160+ TITER,NUCLEOLAR.All the other arhritis profile parameters are in normal reference range.I have PCOS and mild seborrhoeic dermatitis of the face and scalp.Which other tests do you recommend? thank you,Silvia

Feb 4, 2009 10:40 AM

Elaine Moore :

Hi,
You probably want to have the ANA test repeated within a few months. If the titer is still elevated, your doctor might want to run the Scl-70 and PM-scl antibody tests. Joint pain during the menstrual cycle isn't unusual and can be hormonal. You might want to ask the doctor treating you for PCOS about this. I'm assuming you had the sed rate and CRP tests and that they were normal. Best, Elaine

Feb 5, 2009 2:53 PM

Guest :

My daughter is 6. She had a ana at 1:160 and positive HLA-B27. She had a rash and joint pain. She had pe tubes at 12 months old and her tonsils and adnoids out at 18 months (due to recurrent ear infections and strep)Could she be born with connective tissue disease and no tested her unitl she was 5. Her eye sight hasnt recently gotten bad to she had to glasses. Is this not something common in children where they could of caught this earlier.
ms

Feb 6, 2009 9:00 PM

Guest :

My daughter is 16 years old. Last year she became very ill. She lost 40 pounds with an incredible amount of abdomnial pain. Six months after the onset of symptoms, she had an exploratory Laporatomy. They removed her appendix, but found adhesions wrapped around her intestines to the point of an almost complete bowel obstruction. No previous surgeries or injuries. During the course of all the testing, she was tested for her ANA titer. At that time it was 1:640 and mixed speckled with homogeneous. Every other antibody test has been normal. We are at our wits end. She still has extreme fatigue, joint pain and poor appetite. Her joints do swell with some reddness occassionaly. She does have dry eyes and mouth and Raynaud's symdrome. She also has some intractable nerve pain in her right flank. She was hospitalized 4 months ago in acute renal failure. No biopsies were done. She has baffled lots of doctors and some that have given up. She is currently being seen by a Rhumatologist and is on Plaqunel for now. Her lastest ANA level was 1:1280 (I didn't know it oculd go that high). She has a Vitamin D def. and a low Alk Phos level currently. We are at our wits end and she is tired of being sick. I would love any suggestions you may have or that we could talk to her doctors about.
Thanks,
DKK

Feb 7, 2009 9:57 AM

Elaine Moore :

Hi,
Regarding your 6 year old daughter, here's a link to an article abstract that you might find helpful.
http://www.aafp.org/afp/20060715/293.html

You might also want to do a search on uveitis and on Reiter's syndrome. Reiter's can develop after a Strep infection and is highly associated with a positive HLAB27.
Best, Elaine

Feb 7, 2009 11:20 AM

Elaine Moore :

Hi,
With an ANA that high and kidney problems, your doctor would probably want to run tests for ds-DNA antibodies and for histone antibodies. The low alkaline phosphatase level you mention can be seen in hypothyroidism. It would be good to run a thyroid function profile with tests for FT4, FT3, TSH and thyroid antibodies. Hashimoto's thyroiditis can occasionally cause an elevated ANA, cause joint pain, and if antigen-antibody complexes occur it can cause kidney problems. Let us know of any other test results. I hope your daughter gets the proper diagnosis and treatment and soon begins to improve. Best, Elaine

Feb 7, 2009 8:55 PM

Guest :

Elaine,thanks for the response. I will bring up these test to Sarah's doctor. I appreciate any insight into this and will keep you posted with future lab results.
Thank you,
DKK

Feb 13, 2009 6:53 PM

Elaine Moore :

Hi,
I hadn't heard of grumbling disease either so I did a search on google for the terms grumbling connective tissue disease and found a few links.
Here's one
webrheum.bham.ac.uk/professional/under-graduate/4yr/RAVasculitisfull/ Newversion/Vasculitisfull02%5B1%5D.ppt

there's several other links using this search. you might also try for grumbling with vasculitis, and rheumatoid disorders. Best to you, Elaine

Feb 14, 2009 10:52 AM

Elaine Moore :

Hi Ed,
Your son's WBC is low, but not critically low. A low WBC count or leukopenia is typically defined as less than 3.5 K and in children this can vary. In the lab, when the WBC count is below 2.0, we have the pathologist look over the blood smear to look for abnormalities. Along with the WBC count, the complete blood count will list a differential, which is the percentages and also absolute counts for the different kinds of white blood cells, like neutrophils, lymphocytes, monocytes, etc. If the neutrophils are low this is called neutropenia and it's of more concern since this could interfere with the ability to fight infection well. Ask for copies of the results if you don't have them and check the differential to see if the cell types are in range.
I'd be more concerned about the BUN and creatinine. As you mentioned they measure kidney function. Rather than just repeating the tests it would be good if other tests were ordered such as the Glomerular filtration rate or GFR and a urine microalbumin. The BUN and creatinine can also be elevated in urinary tract infections and in other conditions and more tests can help with diagnosing the causes. Did your doctor happen to run a urinalysis? The results from a urinalysis are also helpful in diagnosing kidney disorders.

The ANA can be positive in normal individuals but when it's positive in a child it's a good idea to consult a rheumatologist. The RF and CCP rule out juvenile arthritis, which is one of the more common autoimmune diseases in children. Why don't you see if you can get a referral to a rheumatologist.
For more information on lab tests, the best website is www.labtestsonline.org It's run by the College of Pathologists that oversee laboratories. Let me know if you have any other questions and best to you and your family, Elaine

Feb 14, 2009 10:10 PM

Guest :

Ms Moore,

It is Ed. My wife Yenny and I want to thank you so much for your quick response regarding my 2.5 year old son, Liam. We will arrange an appointment with a rheumatologist on Monday. We are concerned with the potential of an autoimmune disease, especially lupus given his ANA positive result, low WBC, and high BUN ratio. We will keep you posted of his situation. Once again thank you from the bottom of our hearts.

Edward

Feb 15, 2009 9:34 AM

Elaine Moore :

Dear Ed,
I'm happy to help. Feel free to contact me at elaine@elaine-moore.com with any follow-ups. The best to you, Elaine

Feb 24, 2009 12:56 AM

Guest :

I am currently suffering a lot different problems and the doctors have been unable to diagnosis what is wrong with me. I have severe pain in the abdomen - upper right quadrant (which seems to follow the liver). I currently have pain patches to help reduce the pain to a manageable level. I have pain in the shoulders, elbows, wrists and finger joints. The hands are constantly hurting, especially in the joints. I suffer muscle pain in the arms and sometimes in the legs. I get mouth ulcers which come and go. I am suffering hot and cold flushes which make me feel nauseas, dizzy and I get a grainy feeling in the eyes. I am constantly thirsty and need to have water beside me all the time. I am not sleeping well at night and seem to be awake more than I am asleep. I wake up with a lot of pain in my hands, shoulders and abdomen.

I recently had blood test done and my ESR is elevated, I have a positive ANA 1.80 speckled, I have a result of 2.2 IU/ml anti-dsDNA and I also have elevated LFT.

The doctors have said that I just have to accept that I will have to live with the pain in my abdomen and I may never find the answer to what is causing it. They currently think the pain in my shoulders, arms and hands is caused by two extra cervical ribs.

My question is do you think I have lupus, as a lot of the symptoms for lupus match my symptoms. All I know is I am finding it very hard to cope with all this and would really like to know what is wrong with me.

Feb 24, 2009 10:43 AM

Elaine Moore :

Hi,
Your ANA isn't very high at 1:80 and depending on the range your lab uses for dsDNA antibodies, your result may be borderline but I don't see anything striking that points toward lupus. Have you been tested for SSa and SSb antibodies to rule out or help diagnose systemic Sjogren's syndrome? You might also want to look into undifferentiated connective tissue disorders.See www.suite101.com/blog/daisyelaine/undifferentiated_tissue_disease
Best, Elaine

Mar 9, 2009 12:59 AM

Guest :

I have been in the Air Force for a little over 10 years and have had a multitude of shots including 7 anthrax shots, I have had pain in almost all of my joints including headaches blood in my urine blurred vision random upset stomach dry grity eyes, dry nose, and mouth, along with numbness tingeling severe concentration problems at times, random loss of balance ringing in my ears, along with many other problems. I had blood drawn to test for autoimmune disorders. The military Dr. said everything looked normal but told me she couldn't print off a copy of my results, and claims to have no knowledge of Gulf War syndrome, and "squalene" laced shots. After leaving her office I had a friend print them off for me.
my ANA showed in transit with nothing else listed
my Lymph% was slightly 47.5 with 42 being the cut off
my SSA and SSB for Sjogrens >80%* both
my RNP for MCTD >80%*
my Sm for MCTD 31%**
my SSA for SLE 52%**
my RNP for SLE 48%**
my Sm for SLE 42%*
my dsDNA for SLE 45%*
thats it for the high numbers everything else was in the teens or less.

After going to the ER for the pain in lower abdomen and urinating blood the test showed 30 mg of protein, with elevated WBC after retest showed negative. (no STD was Found) "married with kids and faithfull"
Seeing as how I am not a Dr. I have know idea what this means, can someone help me understand what is going on.

thanks Smitty
my email is loki_809@yahoo.com

Mar 9, 2009 8:43 AM

Guest :

Dear Elaine Moore,

I’m a 38-yr-old woman who for the past two years has suffered from extreme fatigue, chronic esophageal spasms, deep muscle pain and frequent cramps in my legs and feet, pain in my hands, and extreme pain and stiffness in my neck. A few months ago my hands started swelling up to the point where I can’t open or close them completely, and the skin on the hands feels leathery and is darker than the skin on the rest of my body. It also cracks and bleeds no matter how much moisturizer I use, so that I always have open sores on my fingers and knuckles. Sometimes I get these little white bumps on my fingers and palms and they take weeks to go away. I seem to be losing the function in my hands, having trouble handwriting and turning pages and opening jars and turning doorknobs. In cold weather, my hands turn white, then two fingers turn dark blue. When I wake up every morning both hands are completely numb/asleep. I used to run a mile every morning but now when I try to run or work out my heart rate shoots up way over two hundred, I have trouble breathing, and I feel like I might pass out. Some days I even have trouble walking uphill, as though my legs just won’t work right. My face has started swelling up and I have all these little red lines like broken blood vessels across my cheeks and around my nose. I saw a rheumatologist and my blood work showed positive ANA with a dual pattern of centromere (titer 1:160) and homogeneous (titer 1:80), and C-reactive protein 1.13. Tests for SS-A, SS-B, lupus anticoagulant and SCL-70 were all negative. My rheumatologist has diagnosed me with fibromyalgia, and said the ANA could be a false positive. She said I might have undifferentiated connective tissue disease but I don’t have enough symptoms for her to diagnose and treat me for that. She just wants to treat the fibromyalgia, but I’m not sure that’s what I have. I’m afraid I may be in the early stages of a much more serious, progressive disease where early treatment might make a difference. What would you recommend? Thanks for your advice.

Mar 9, 2009 11:10 AM

Elaine Moore :

Hi Smitty,
I'm not sure why your ANA test said it was in transit or still pending and then results were listed. I'm also not sure why she would have said the results were normal.

Some of your symptoms along with positive results for SSa and SSB could suggest Sjogren's syndrome. Why don't you ask for a referral to a rheumatologist? Rheumatologists specialize in autoimmune connective tissue disorders.
See autoimmunedisease.suite101.com/article.cfm/connective_tissue_disorders

The urinalysis test isn't usually used to test for STDs although urine can be used to test for gonorrhea and chlamydia. The most common urinalysis test looks for blood, glucose, white cells, etc to help diagnose urinary tract infections, kidney disease, kidney damage, diabetes, etc. Protein is positive when red blood cells are present. Usually if there are enough red blood cells to show protein patients are referred to a urologist or rheumatologist. Some autoimmune diseases, including systemic lupus, can affect the kidneys. Because symptoms in autoimmune disease wax and wane sometimes labs are positive and sometimes negative.

The lymphocyte count can be elevated in viral infections. Usually the absolute lymphocyte count is regarded as more important than the percentage of lymphocytes present in the diff. If the total white blood cell count is abnormal, then the absolute count of lymphocytes is abnormal. Best, Elaine

Mar 9, 2009 11:34 AM

Elaine Moore :

Hi,
It's true that early treatment can make a difference in many of the autoimmune conditions. Much of what you're describing sounds as though it could be related to scleroderma or systemic sclerosis or eosinophilic fasciitis.
See autoimmunedisease.suite101.com/article.cfm/eosinophilic_fasciitis
Some of your symptoms also sound as though they could be related to thyroid disease.

It would be helpful to have tests for thyroid function, thyroid antibodies, and the SCL-70 antibody test.

The American Association of Autoimmune and Related Disorders www.aarda.org once reported that it can take up to 7 years to get a proper autoimmune disease diagnosis. Proactive patients can help speed up the process. You might want to ask your doctor about low dose naltrexone as well since early reports of the Stanford Clinical Trial of LDN in fibromyalgia are looking promising. LDN is also reported to reduce disease progression in some patients with scleroderma. Do you have the typical trigger points and other diagnostic criteria for fibromyalgia? Best, Elaine

Mar 10, 2009 7:51 AM

Guest :

Dear Elaine Moore,

This is the 38-yr-old woman again. To answer your questions, my internal medicine doctor did blood work to check for anemia, type two diabetes and thyroid problems. All the blood work was normal. I do have several of the trigger/pressure points for fibromyalgia, as well as mild sleep apnea, brain fog/concentration and memory problems, and chronic fatigue. I just want to be sure that another disorder isn’t causing these and my other symptoms. Thanks for mentioning scleroderma, systemic sclerosis and eosinophilic fasciitis. I’ll ask my doctor about those disorders, and about the low dose naltrexone. I’ve made an appointment with a dermatologist who has treated people with scleroderma, and have also considered getting a second opinion from another rheumatologist just to be sure. I’m especially concerned about the loss of function in my hands. I really enjoy drawing, and would be devastated to lose my artistic ability. Thanks again for your advice.

Mar 11, 2009 9:27 AM

Guest :

I HAVE A POSITIVE ANA TEST 1:320 IN A SPECKLED PATTERN. iHAVE BEEN TOLD I HAVE MIXED CONNECTIVE TISSUE DISORDER. DOES MY ANA TEST SUGGEST ANYTHING SPECIFIC.

Mar 11, 2009 3:43 PM

Elaine Moore :

Hi,
The speckled pattern suggests several different conditions including mixed connective tissue disease. Other tests, such as the ds-DNA antibody test, are used to help diagnose specific disorders. These tests are also correlated with symptoms and signs. It could be that your symptoms and signs point toward mixed connective tissue disease. Best, Elaine

Mar 13, 2009 3:55 PM

Guest :

My daughter has complained about joint pain, back ache, fatigue, depression, skin hurting. Last yr ANA test negative. This year ANA Positive <1:40
She is frustrated and can't find help. Primary thinks she should be on anti depressants. Rheumatoid Dr did additional tests..SM/RNP aB 2.5 POS...what does all this mean? Looking for a doctor to really help her. She's 20 and suffering with leg pain, stiffness. We have been to primary several times. and 2 specialist; all agree there's "something" but not enough to direct us to what's wrong.

Mar 13, 2009 7:38 PM

Elaine Moore :

Hi,
I'm sorry to hear that your daughter isn't feeling well.
The RNP test is usually positive in mixed connective tissue disorders.
See www.suite101.com/blog/daisyelaine/undifferentiated_tissue_disease and
autoimmunedisease.suite101.com/article.cfm/connective_tissue_disorders

With the RNP test being a low positive it's probably difficult to make a definitive diagnosis. And some of these conditions resolve on their own. Has your daughter had an MRI or any imaging tests? These can be helpful when blood tests are ambiguous. Best, Elaine

Mar 17, 2009 6:21 PM

Guest :

While trying to determine the cause of my fertility issues, my doctor ran a ANA test.

My results were Mixed Pattern
1:320 Homogeneous / 1:320 Speckled

I have no idea what this means--doctor only put me on daily 81mg aspirin for what he called "non-specific antibodies". Can anyone help? What do my results mean? Thank you in advance!

Mar 18, 2009 8:21 AM

Elaine Moore :

Hi,
The ANA isn't a specific test. Sometimes it's positive for no reason. To help with diagnosis your doctor will probably run a few other tests. Or perhaps he did and the results are inconclusive.

One of the most common autoimmune conditions is antiphospholipid syndrome.

See autoimmunedisease.suite101.com/article.cfm/antiphospholipid_syndrome

It's a common cause of miscarriages because it causes the blood to clot too quickly. The usual treatments are aspirin or heparin. I hope this helps. Best, Elaine

Mar 26, 2009 10:00 PM

Guest :

Dear Elaine,

After years of joint pain, weakness, fatigue, Raynaud's, rapid weight loss,facial flushing and extreme flushing of hands in feet during summer, I tested positive for ANA 1:640, homogeneous. However, none of the other autoimmune tests were positive; sed rate is sometimes high, sometimes normal, RH factor negative. The positive ANA was 5 years ago. Since then my voice became much weaker, started having swallowing problems, drooping eye, and was sent to a neurologist. Myasthenia gravis tests were normal. Two years later I could not lift my arms over my head for more than a few minutes, started having hand tremors. Was sent to Methodist Hospital to rule out ALS. Brain MRI normal. I have never been diagnosed with anything except osteoarthritis. I have been to rheumatologist and neurologists, but I cannot use my arms for very long, my hands are shaking,I lose my voice by the middle of the day, my drooping eye and red face and staggering walk make me look like I'm drunk, and my feet look like I've got flaming red kneesocks on. Help! Oh, and my grandmother had rheumatoid arthritis, her brother was diabetic, and my cousin's teenage son was just diagnosed with lupus.

Mar 27, 2009 6:48 PM

Elaine Moore :

Hi,
Has your doctor mentioned the possibility of systemic Raynaud's disease or have you had your thyroid levels checked lately. Hypothyroidism can affect the voice and cause muscle weakness. Hyperthyroidism also causes weakness, particularly of the upper body. It's unfortunate, but sometimes autoimmune diseases can take years to properly diagnose. Best, Elaine

Apr 9, 2009 10:46 AM

Guest :

My 5 year old daughter has a swollen knee with fluid behind the joint and a positive ANA titer of 1:1280. She has no pain. Normal Sed rate, normal Xray, negative for lyme disease. We need to now see a juevenile rheumatologist but have to wait months to even be seen. Any initial ideas on initial diagnosis, any advice as we move forward? I need something to get me through the next few months. Thanks so much.

Apr 9, 2009 11:39 AM

Guest :

What are your thoughts: ANACHOICE(TM)SCREEN POSITIVE A
ANA PATTERN NEGATIVE
C-REACTIVE PROTEIN HIGH 3.91

Apr 23, 2009 7:12 AM

Elaine Moore :

Hi,
Lab tests serve as guidelines and help with diagnosis, but results still must be correlated with symptoms for the reasons you describe. Some people have low levels of immunoglobulins and don't produce antibodies or autoantibodies very well. You could have ANA at levels below what we detect. Also, ANA often only rise during periods when there's flares of symptoms. And oddly people can have a negative ANA titer and later test positive for one specific ANA such as anti-RNP in people with connective tissue disorders. It's a good think you went to a rheumatologist who understood this. The procedure for ANA has changed somewhat in recent years and is more specific. If your doctor thinks it's worth it he could always order the test again if you haven't had one in a while. But it doesn't sound necessary, especially if you're responding well to meds. A test for thyroid antibodies could also be helpful and help in explaining some of your anaphylactic reactions. Best, Elaine

Apr 23, 2009 10:20 PM

Elaine Moore :

Hi R,
You're more than welcome. Remember to read about the importance of lifestyle changes and diet for autoimmune disorders. Best to you, Elaine

Apr 24, 2009 6:34 PM

Guest :

Please help. I have cervical syringomyelia (around C5-T1, and about 3.5mm) It's been stable for a number of years and I believe it is still stable> I also have C5-6 fusion with hardware installed which was performed about 3 years ago, it was a very successful surgery.

About 2 weeks ago I thought I slept wrong on my neck and have had increasing neck and left arm radiculopathy (mostly down to my index finger). I treid the usual motrin every six hours and now 2/3 way through a medrol dose pack. No relief yet. While there is some DJD above and below the cervical fusion, recent MRI didn't show any pinched nerve, which my doc and I thought for sure was the cause. However, the MRI did show an inflammatory "inside" some of my cervical nerve roots, so the doc order tons of blood work. The Angiotensin-1-converting return a high result of 72, so the doc is have a chest X-ray to check for sarcoidosis, but I have had not breathing problems. The test also showed and anti-nuclear AB titer of 1:80 with a "speckled" ANA pattern. The nerve pain in my left arm and hand (index finger) is sever, but I don't have the normal muscle spasms like I used to when I knew it was a disc problem before the surgery. Any thoughts?

Apr 25, 2009 8:40 AM

Elaine Moore :

Hi,

It's hard to say for sure what's going on. Sarcoidosis can target other organs besides the lungs so your doctor may want to run more tests.
See
http://autoimmunedisease.suite101.com/article.cfm/sarcoidosis

The ANA test at a low titer of 1:80 can be elevated for no specific reason. Your doctor may want to run more tests to see if any specific antibodies such as dsDNA are also elevated. Best to you, Elaine

May 12, 2009 1:36 PM

Elaine Moore :

Hi,
Your titer at 1:2560 is quite high and it's probably not a false positive. Are you on any medications that could cause drug related lupus or drug related arthritis? Here, the ANA is positive and symptoms resolve when the offending drug is stopped.
See:
autoimmunedisease.suite101.com/article.cfm/drug_related_lupus

and also

autoimmunedisease.suite101.com/article.cfm/drug_related_arthritis

Some of your symptoms such as thinning hair sound similar to symptoms seen in hypothyroidism. It would be good if you had tests for thyroid function and also a RF titer for rheumatoid factor. Best, Elaine

May 17, 2009 7:07 PM

Elaine Moore :

Hi Sherree,
Many autoimmune disorders are characterized by periods of symptom flares that alternate with periods of remission. You might want to see your rheumy while you're having a flare, which is when blood tests are more likely to be positive. Often, meds can help flares from occurring. Best, Elaine

May 18, 2009 3:35 PM

Guest :

I have had a positive ana and a positive ss-a. Would anyone have a cluse what that means. My ana is use to be 561, now its ranges changes to >8.0. It has me all confused. I was told sjogren's and rheumatoid arthritit. I am feeling much bette and labs look much worse. Who knows, can anyone help me.

May 18, 2009 7:56 PM

Elaine Moore :

Hi,

The Rheumatologist Association has come up with specific diagnostic criteria for the various connective tissue diseases.
Here's the link http://www.arthritis.co.za/criteria.html
and you'd want to click on systemic lupus erytematosus as well as some of the other connective tissue disorders. According to the criteria out of 11 features, 4 need to be present for a diagnosis of lupus. An ANA titer greater than 1:40 and a positive ds-DNA are both diagnostic criteria. There are some skin manifestations listed that often look like a butterfly rash but the lesion you mention could fit.

The anti-Ro or SSa is more often positive in Sjogren's Syndrome. The RF test isn't usually positive in lupus. It would be good to have an RNP to see if undifferentiated connective tissue disease is a possibility. See my article on UCTD www.suite101.com/blog/daisyelaine/undifferentiated_tissue_disease

Has your doctor run a metabolic profile to check kidney or liver function? Any pulmonary function tests?

Meds are good for preventing flares but if you have UCTD without symptoms, you may want a second opinion before starting any meds. Best, Elaine

May 18, 2009 8:32 PM

Elaine Moore :

Hi,
Your labs haven't gotten worse. There's been changes in the methods. In the old tests we made serial dilutions of serum and reported the highest dilution that was positive. Often, we'd only dilute the serum up to 8 and report a positive as greater than 8. In the newer, more sensitive tests, we dilute serum to very high dilutions, for instance 2560. And for some tests, a concentration rather than a dilution is reported. ANA and SSA are both positive in sjogren's syndrome. Systemic sjogren's can cause arthritis. If you have rheumatoid arthritis, you probably also have a positive rheumatoid factor (RF) test. Best, Elaine

May 20, 2009 8:44 AM

Guest :

42year old white male - fit military officer.

Blood tests, as a last result, for small spot under eye revealed additional information:

Positive ds DNA
Positive Ro
Positive rheumatoid factor
ENA and Lymphopaenia Positive
ANA 1280

Doctor now says spots under eye nt related - see dermatologist. Bu that I have probably got Lupus, even though no clinical symptoms (I'm fine and healthy).

Wants to put me on 200mg daily of Hydrocholoroquine.

What do you think?

May 21, 2009 12:10 AM

Guest :

Hi, Was just wondering if you could shed some light on my situation. 6 months ago my Doctor sent me for blood tests after a turn at work (I could not comprehend anything, lost my memory for a period of time, dizzy), I also suffer from alot of migraines. My blood tests returned reading ANA positive, specked, 1:80. The Dr advised me to take immune boosters and retest my blood in 3 to 6 months. At which time the result came back 1:160. The doctor seemed unconcerned and advised me to retest again in 3 months, This was a week ago. Sense this time i have broken out in a rash that covered most of my body (the Dr said it was a viral rash), i have developed joint pain, very painful, even more so in the morning (fingers, wrists, elbows, knees, ankles and toes, on both sides of my body), am having hot flushes, very fatigued, and am quite concerned. I have been back to the doctor who insisted there would be no point retesting the ANA and just prescribed anti-inflammatory. I am frustrated as i know something is not right and am unsure as to my next step or what this could be????
Thank you for any help!!!
Nic

PS- im 26 years old, female

May 21, 2009 10:43 AM

Elaine Moore :

Hi Nic,

It's hard to say what it might be without more blood tests. Usually, when an ANA test is positive, one's doctor will order more specific tests to help with the diagnosis. If a viral disorder is suspected, viral serology tests are also performed. It would be good to see a rheumatologist. Rheumatologists specialize in connective tissue disorders and would have a better idea of what tests would be helpful. Best, Elaine

May 21, 2009 10:59 AM

Elaine Moore :

To Fit Military Officer,

I'm not sure why your post isn't showing up. I've confirmed it several times.
Here's the reply I wrote on 5/18:

Hi,

The Rheumatologist Association has come up with specific diagnostic criteria for the various connective tissue diseases.
Here's the link http://www.arthritis.co.za/criteria.html
and you'd want to click on systemic lupus erytematosus as well as some of the other connective tissue disorders. According to the criteria out of 11 features, 4 need to be present for a diagnosis of lupus. An ANA titer greater than 1:40 and a positive ds-DNA are both diagnostic criteria. There are some skin manifestations listed that often look like a butterfly rash but the lesion you mention could fit.

The anti-Ro or SSa is more often positive in Sjogren's Syndrome. The RF test isn't usually positive in lupus. It would be good to have an RNP to see if undifferentiated connective tissue disease is a possibility. See my article on UCTD www.suite101.com/blog/daisyelaine/undifferentiated_tissue_disease

Has your doctor run a metabolic profile to check kidney or liver function? Any pulmonary function tests?

Meds are good for preventing flares but if you have UCTD without symptoms, you may want a second opinion before starting any meds. Best, Elaine

Jun 4, 2009 9:06 AM

Elaine Moore :

Hi Rachel,

A low TSH is seen in hyperthyroidism, and the most common cause of hyperthyroidism in young women is Graves' disease. Graves' disease can sometimes cause a positive ANA test.
With the newer instruments used for urinalysis we see red blood cells more often as these newer methods are more sensitive. Protein is pretty common when red blood cells are present. Blood and protein can also be a sign of kidney disease especially if the concentrations are high. But your doctor probably also ran kidney function tests like the bun, creatinine, phosphorus and glomerular filtration rate. Even if these tests are ok, you might want to see a urologist.

I don't see any indication that you might have lupus but it's hard to say not knowing what the ANA result was and what pattern it showed. Offhand, I'd say Graves' disease is much more likely. You can find out more about Graves' disease on my website at www.elaine-moore.com. Best, Elaine

Jun 6, 2009 12:51 AM

Guest :

Hi, I am a 24 y/o woman. I have had chronic hives with sensitivity to light and heat, with no known allergies for 11 years, unexplained anemia, headaches, occasional pleurisy, fatigue, depression, joint discomfort, recent back pain and recent tingling and numbness in my hands. Positive speckled ANA w/ low titer (1:40 or 1:80), elevated ESR, decreased Albumin, and increased Alpha-2 fraction. Until recently, neither I nor my doctors suspected these things were related... until my labs came back. I am being tested soon to r/o lupus, but from what I've read, there is no definitive test. Thoughts?

Jun 6, 2009 9:29 AM

Elaine Moore :

Hi,
Your ANA of 1:40 or 1:80 is low enough to be a false positive. It's also the kind of result seen in other autoimmune disorders that aren't connective tissue diseases, for instance autoimmune thyroid disease.

Many of your symptoms, including joint pain and hives, are associated with autoimmune thyroid disease and/or thyroid antibodies. It would be good to have thyroid function tests and tests for thyroid antibodies.

It's true there isn't a specific blood test used to diagnose lupus. However, there's certain criteria including a positive ANA and a positive ds-DNA and rash. You need to have several positive signs for a diagnosis.

If your hands also hurt at times or turn red or white, you could ask about Raynaud's, which can occur with other autoimmune disorders, including thyroid disease. Either way, you'll likely need several more blood tests to get a better idea of what's going on. You're probably right though that these symptoms are related. Best, Elaine

Jun 15, 2009 6:52 PM

Elaine Moore :

Hi,
The ANA test can be negative during times of remission in patients with lupus. Autoimmune diseases such as lupus are characterized by periods of symptoms alternating with periods of remission. Best, Elaine

Jun 19, 2009 7:20 PM

Elaine Moore :

Hi,
I'm sorry to hear you're not feeling well.
Gabapentin works well to reduce pain and you might find that it gives you relief. You might want to ask too about treatment for the microorganisms found in your urinalysis test. You might want to ask your doctor too about your diagnosis. Some of your test results suggest a mixed connective tissue disorder.
See autoimmunedisease.suite101.com/.../mixed_connective_tissue_disease

I hope you start to feel better soon. Best, Elaine

Jun 23, 2009 9:23 PM

Elaine Moore :

Hi,
Since you mention having gluten sensitivity, you might want to read this article I wrote:
autoimmunedisease.suite101.com/.../atypical_celiac_disease_symptoms

It explains how arthritis pain can occur in celiac disease. Soy sensitivity causes similar symptoms as gluten sensitivity. I've had arthritic pain that resolved when I stopped eating gluten.

I'd have the ANA test repeated after stopping the foods you're intolerant of and see if it's still high then. Autoimmune thyroid disorders also often occur in people with gluten sensitivity and they too can cause an elevated ANA. You might ask to have thyroid function tests as well.

Your doctor will also probably run some other tests like ds-DNA to see if there's a specific antigen causing the positive ANA. Best, Elaine

Jun 26, 2009 4:10 PM

Elaine Moore :

Hi,
An ANA of 1:40 is low and often occurs as a false positive. Since your RNP is positive as well, it's good to follow up with a rheumatologist. Has your GP ordered any thyroid function tests? Hypothyroidism can cause problems with body temperature regulation and joint pain, and it can also cause a positive ANA. Best, Elaine

Jun 28, 2009 6:37 PM

Elaine Moore :

Hi Laney,
Although thyroid eye disease usually occurs in hyperthyroidism (Graves' disease), 10% of cases occur in patients with Hashimoto's thyroiditis. Eye dryness can be a symptom.
Your SSa and SSb test results suggest Sjogren's and that can cause eye dryness. You could also have oral dryness and that may be why you're drinking more water. Other tests can be done, such as saliva measurements, to help with a diagnosis of Sjogren's. Let us know how your other test results look. Best, elaine

Jun 29, 2009 7:42 AM

Elaine Moore :

Hi Laney,
Neutropenia can occur in either Sjogren's or Lupus and it can occur in many other disorders, including reactions to medications and, more commonly, viral infections.

Neutropenia isn't listed in the criteria for either disorder and neither of these conditions are common causes of neutropenia. Because connective tissue disorders are inflammatory conditions, higher WBC counts are more commonly seen than low counts. Low WBC counts are more common in people with these disorders who are on immunosuppressant medications. Neutropenia certainly wouldn't be a reason for someone to suspect lupus. Best, Elaine

Jun 29, 2009 8:13 PM

Elaine Moore :

Hi,
Plaquenil can have its own side effects. I did find an article by Dr.Thomas on
www.lupus.org/webmodules/webarticlesnet/templates/new_empty.aspx?articlei d=2307&zoneid=76

where he states that a low WBC can help diagnose lupus. so that's where she got this. This isn't what we see in the lab though, and it's not listed with the diagnostic criteria. Dr. Thomas, does, however say that drugs to increase the WBC count aren't necessary. I'd still hold off until you have a definitive diagnosis. Best, Elaine

Jul 1, 2009 11:09 AM

Elaine Moore :

Hi,
Carpal tunnel syndrome is a common side effect of hypothyroidism. You want to look at your FT4 and FT3 levels. This will help determine if you're on the right type and right amount of thyroid hormone. You're on T4 alone. Some people after RAI need to be on T3 as well as T4 therapy to prevent symptoms of hypothyroidism.

RAI dramatically stimulates the immune system. This can result in production of antinuclear antibodies (ANA). Your low titer isn't necessarily associated with another autoimmune disease.

MCH has to do with the mean corpuscular hemoglobin or how much hemoglobin on average is in each red cell. In hypothyroidism the MCH can be low, and people sometimes become anemic. The RDW has to do with the average red blood cell diameter. An RDW higher than 15 shows that there's more variation than usual in the size of the red cells. If you have some type of anemia, the RDW and MCH can help with classifying it. If you don't these levels aren't significant.

Best, Elaine

See my website, www.elaine-moore.com

Jul 6, 2009 8:04 PM

Elaine Moore :

Hi,

None of your results are particularly strange other than the ANA, and the ANA can be positive for no reason. Still, in autoimmune diseases symptoms wax and wane and ANA results fluctuate. That's why it can take several years before a diagnosis is made. And if the joint pain and ANA results aren't caused by a connective tissue disorder symptoms and labs resolve spontaneously. You could ask your doctor to run tests for Lyme Disease and Human Parvovirus B19.
See autoimmunedisease.suite101.com/.../human_parvovirus_b19_infection
These disorders can also cause the symptoms you're having. Best, Elaine

Jul 27, 2009 11:37 AM

Elaine Moore :

Hi,
An ANA of 1:40 isn't usually significant. This can occur in people with no medical problems. But because of your symptoms, your doctor may want to repeat this test in several months.
Have you had your thyroid levels checked? The sweating could be a sign of hyperthyroidism.
The MCH component of the CBC is based on a calculation and can be falsely affected by different medications. That may be what happened. Best, Elaine

Aug 4, 2009 9:20 PM

Elaine Moore :

Dear Guest,

Double vision can occur in several different conditions including autoimmune thyroid disease. In the disorder known as Graves' ophthalmopathy or thryoid eye disease (TED), the eye disease runs its own course independent of the eye condition. About 10% of all cases occur in people with hypothyroidism and 80% of cases occur in patients with Graves' disease. Most everyone with Graves' disease initially has hypothyroidism, although it's often not diagnosed.
Your ANA titer, while elevated, is low and could be related to your thyroid disorder. You might want to read my articles on TED and Graves' disease and visit my website at www.elaine-moore.com. Best, Elaine

Aug 5, 2009 12:35 PM

Elaine Moore :

Hi,

Insurance concerns with the new multiplex ANA tests still abound. Many insurance companies feel that since the tests measure a variety of different antibodies, tests may be done that aren't needed. This is one reason labs had to stop offering various panels. Your ANA result of 1:280 could be related to your hypothyroidism or be associated with a connective tissue disorder. It's good that you're going to see specialists. Your symptoms are associated with a number of different conditions. Your description of headaches sounds like the classic description of hypertension headaches but could also occur in vascular conditions.
Without further tests, it's difficult to say, but it would be good if you'd let us know what other tests you have done and what the specialists have to say.
Best, Elaine

Aug 8, 2009 3:34 PM

Elaine Moore :

Dear Guest:

Are you on folic acid, vitamin B12, and vitamin D to correct these deficiencies? If you're not responding to the meds and are still having pains, you might consider consulting with another doctor or adding alternative medical therapies along with dietary changes. Boswellia may help with the arthritic pain of MCTD and RA. See my article www.suite101.com/blog/.../boswellia_reduces_inflammation

Low dose naltrexone also works well in rheumatoid arthritis.
See autoimmunedisease.suite101.com/article.../low_dose_naltrexone

An anti-inflammatory diet can also help. Best, Elaine

Aug 11, 2009 9:40 AM

Elaine Moore :

Hi,
With your ANA rising from 340 to 1280 your doctor will likely order more specific tests such as ds-DNA and SCL-70 to help with your diagnosis. Since the ANA is a generalized rather than a specific test your results suggest an autoimmune process but don't specifically point to one thing. If you're not seeing a rheumatologist you might want to make an appointment with one. Best, Elaine

Aug 11, 2009 10:01 AM

Elaine Moore :

Hi,
Your 1:80 ANA doesn't necessarily mean that something else is going on. It could be related to your fibromyalgia. Low titers are also sometimes seen in the normal population and in autoimmune thyroid disorders. A positive ANA is not an indication of cancer. The studies of low dose naltrexone for fibromyalgia at stanford are showing some promising results. See my articles on this topic. Best, Elaine

Aug 11, 2009 7:29 PM

Elaine Moore :

Hi,
I didn't see what the IFA titer of your daughter's was. If it's lower than 1:80 it could be a false positive. If she still has joint pain you might want to consult a rheumatologist. Best, Elaine

Aug 12, 2009 1:01 PM

Elaine Moore :

Hi JD,

Your titer is higher than what's usually seen in a false negative but if no antibodies should up on the specific tests, an undifferentiated or mixed connective tissue disorder is possible. Usually, be "seronegative" labs mean that the test for rheumatoid factor (RF test) is negative. This is common in the spondyloarthropathies.
Please see autoimmunedisease.suite101.com/.../the_spondyloarthropathies
Best, Elaine

Aug 12, 2009 3:07 PM

Elaine Moore :

Hi,
the IFA is considered the gold standard by the American Association of Rheumatologists. I'd consider the choice as a false positive. Best, Elaine

Aug 13, 2009 2:03 PM

Elaine Moore :

Hi,
It's good to see your ANA titer has fallen, and it's good that you had this MRI test now. It's unfortunate that it takes so long to get in to see the rheumatologist. You might consider a neurology appointment too if you haven't. Best, Elaine

Aug 13, 2009 2:07 PM

Elaine Moore :

Hi Tracy,

I just noticed your consult was with a neuro.

By ACE, do you mean the acetylcholinesterase test or did you have test for acetylcholine receptor antibodies? Please clarify. Thanks, Elaine

Aug 14, 2009 1:11 PM

Elaine Moore :

Hi Tracy,

See http://www.labtestsonline.org/understanding/analytes/ace/glance.html
for more info on the ACE test. Be sure to hit next to move on to the next screens to see other conditions that may cause an elevated test result.

Sarcoidosis doesn't always involve the lungs. I wrote an article on sarcoidosis of the thyroid gland and have met several people with this condition. I was interested to see the ACE can be elevated in hyperthyroidism, something I hadn't realized.

Please follow-up and let us know how things turn out. Best, Elaine

Aug 14, 2009 4:37 PM

Elaine Moore :

Hi,
I'm sorry to hear that your rheumatologist visit went so poorly. It seems your PCP has a better idea of what's going on and how to treat it than the rheumatologist.
Ibuprofen can, while reducing joint pain, cause inflammation and also raise blood pressure in some people. You might want to look into boswellia.

It's true that the ANA and RF can come up positive in times of flares and with negative results at other times, especially in periods of remission. Do you have any of the nodules characteristic of rheumatoid arthritis? It sounds more like an undifferentiated connective tissue disorder. See www.suite101.com/blog/.../undifferentiated_tissue_disease Best, Elaine

Aug 24, 2009 6:15 PM

Elaine Moore :

Hi,
Your positive ANA could be from an autoimmune disorder but more blood tests are needed before your doctor can diagnose your condition. Since you mention hair loss and your titer is low, having thyroid function tests would probably be a good idea too. Best, Elaine

Sep 4, 2009 6:42 PM

Elaine Moore :

Hi Sherry,

IFA refers to an immunofluorescent immunoassay methods. Rheumatologists consider the IFA a gold standard or best method for ANA. It should be more specific but it's still a tricky test to do and subject to interpretive errors. The newer screening tests aren't as specific as they test for a number of antibodies at one time. A titer as low as 1:80, though, is likely to be a false positive.

Antibodies to myelin are seen in MS and other neurological disorders. However, there can also be false positives. For MS, a spinal fluid analysis and an MRI would give more information.

You probably want to have thyroid tests as some of your symptoms suggest hypothyroidism, and this disorder can also cause a false positive ANA. Sorry for the delay in responding. Best, Elaine

Sep 6, 2009 10:03 AM

Elaine Moore :

Hi,
Your doctor will likely run more blood tests to tell what type of specific ANA antibodies you have. For instance, a test for ds-DNA antibodies would be used to test further for lupus. Joint pain occurs in the connective tissue disorders. See:
autoimmunedisease.suite101.com/.../connective_tissue_disorders and also
autoimmunedisease.suite101.com/.../mixed_connective_tissue_disease

Since you mention hair loss, it might be helpful to also have thyroid function tests. Best, Elaine

Sep 13, 2009 11:34 AM

Elaine Moore :

Hi,
It does sound like you may have an undifferentiated or mixed connective tissue disorder. Your lupus anticoagulant test being positive doesn't mean that you have lupus. It refers to an autoimmune clotting condition. See my articles on lupus anticoagulant and on antiphospholipid syndrome. Ask your doctor if treatment is needed.
Keeping vitamin D in the normal range helps undifferentiated connective tissue disease from progressing. Read my articles too on the diet and lifestyle changes that can help reduce symptoms in lupus and other connective tissue disorders. Best, Elaine

Sep 14, 2009 5:45 PM

Elaine Moore :

Hi,
Two different titers can suggest two distinct anti-nuclear antibodies. When you have the ANA repeated, it would be helpful to have tests for ds-DNA antibodies and scl70 antibodies along with a CBC and biochemical profile. Best, elaine

Sep 20, 2009 12:03 AM

Guest :

I have been having problems for a few years. My son passed at the age of 2 in 1995. The summer of 1995 I broke out with a rash and it lasted a couple of weeks. It not only itched but had a burning sensation to it and cold clothes seem to ease both the itching and burning. Neighbor said it looked like sun poisoning. I thought that was weird. So from 1995 to the year 2000 I would break out in this rash where ever my skin was exposed lasting anywhere to 2-3 wks. I would avoid the sun never went to doc didn't have insurance. Now I am expericing new symptoms, joint pain, muscle stiffness, chronic fatigued, dry eyes, dry mouth, low fever. I went to see an ENT because my lymnodes swelled to find out i have Sjogrens. He is referring me to a Rhematolgist with the intentions that Sjogren's is secondary. ENT confirmed SS with lip biopsy. My ANA test was Pattern Nucleolar, Titer 1:640, Anti-SS-A 0.4, Anti-SS-B >8.0 H AI, and Sed Rate 13. Any insights.
RNH

Sep 25, 2009 5:36 PM

Guest :

I am very confused as I was called into my Dr office last week and told that I had arthritis. My Dr said that they were running an additional ANA. These are the results
ANA Direct: Positive: Abnormal
Rheumatoid Arthritis Factor: 8.8 Normal
AST (SGOT): 42 (high)
Thyroxine (t4) free, direct,: 0.92 (low)
TSH: 5.690 (high)
Sedimentation Rate-Westergren: 21 (High)
C-Reactive Protein, Quant: 36.8 (high)
MCV:76 (low)
MCH: 24.4 (low)
RDW: 16.8 (High)
Monocytes: 3 (low)
I also have swelling in my hands, legs, ankles and feet. I have pain in all of the joints on the right side of my body at the moment as well as my arms and legs having tingling and that fall asleep feeling. I have been exhausted for so long now that I don't remember what its like to have energy. I also have some chest pain as well as a hard time taking deep breaths. It doesn't hurt to breathe regularly though. My Dr has referred me to a Rheumatologist but in the past three days I haven't even gotten a call back to set an appt. Any advice would be helpful. I was diagnosed Hypothyroid about 4yrs ago but none of these other values showed in blood work until now.

Sep 25, 2009 5:37 PM

Guest :

Sep 25, 2009 8:39 PM

Guest :

Sep 26, 2009 3:28 PM

Elaine Moore :

Hi,
Your borderline low FT4 and elevated TSH indicate that you're not on adequate thyroid replacement hormone. This can cause a positive ANA and symptoms of arthritis. The sed rate and CRP show that there's inflammation and the RF factor indicates that you don't have rheumatoid arthritis. Your abnormal test results may indicate that something is going on besides hypothyroidism, but it's also possible that correcting your hypothyroidism will take care of things. Best, Elaine