Re: Re: scared.

[Guest guest]

That's great that your daughter will be seen so quickly, Jane.

I hope it is a false alarm. Until then, keep repeating: ANA positivity

is not specific to lupus, and it can occur in people without disease.

Here's a very recent abstract from the last ACR meeting that may

reduce the worry somewhat:

*************************************************

[Abstract 1845] - Assessing the ANA Test as a Screening Tool: Utility

or Futility?

Aryeh M Abeles, MD1,Micha Abeles, MD1. 1University of Connecticut Health Center

Introduction: Current ANA testing may be overly sensitive, resulting

in frequent false positives as well as unnecessary follow-up testing

and misdiagnosis. Several studies have focused on ANA prevalence and

predictive value, but the purpose of this investigation was to

evaluate the clinical utility of a positive ANA test in a real-world

setting, by reviewing the outcomes of patients referred to a tertiary

rheumatology clinic for evaluation of a positive ANA test. No prior

study has directly addressed this question.

Method: We reviewed records for all consultation patients presenting

to the authors at the UCHC rheumatology clinic between July 2007 and

July 2009. Patients were included in the evaluation if they had been

referred for a positive ANA. Patients presenting with an

already-diagnosed ANA-associated rheumatic disease (AARD) were

excluded. All ANA tests and all referrals had been ordered by

non-rheumatologists. A complete review of systems and physical

examination was performed on each patient. 91 out of 101 patients with

ANA titers ≥1:320 had the following labs drawn: antibody (Ab) panel

(Anti-dsDNA, SSA/SSB, Sm, RNP), C3, C4, CH50, CBC, and ESR. Of 67

patients with ANA ≥1:640, 64 had lab evaluations performed as above.

Referring physician reasons for ordering ANA testing were also

collated.

Results: Of 1,306 initial consultation visits to our clinic, 232 were

referrals for a positive ANA, with titers ranging from 1:40 to greater

than 1:5120. Initial ANA testing had been performed at several

different laboratories (the majority at UCHC). 98% of all initial ANA

tests had been run using immunofluoresence assay with Hep-2 cells.

9.1% of patients evaluated (21/232) had an AARD (5 SLE, 12 Sjogren's

syndrome, 3 scleroderma, 1 MCTD). The remainder of patients had no

AARD, of whom twenty-one (9.1%) had isolated autoimmune thyroid Ab

present. No patient with an ANA ≤1:80, and only 1 patient with

ANA≤1:160, had a rheumatic disease. There was no correlation between

the highest ANA titers with a specific rheumatic illness. The most

common reason for ordering ANA testing was widespread pain and

tenderness (54/232, 23.2%) but also included, among others, chronic

lower back pain, episodic chronic rhinitis, palpitations, thinning

hair, unilateral heel pain, and lateral buttock pain. The positive

predictive value of an ANA test in our cohort of patients was 2.2% for

lupus and 9.1% for any AARD.

Conclusion: In this retrospective study, over 90% of patients referred

to a tertiary rheumatology clinic for positive ANA testing had no

evidence of an AARD. The poor predictive value of a positive ANA test

may in part be attributable to poor patient selection with concomitant

low pretest probabilities. The extremely low positive predictive value

of ANA tests at titers below or equal to 1:160 suggests that the

cutoff of a “positive†ANA may need to be re-evaluated by testing

laboratories. Even at high titers, however, many patients referred for

a positive ANA had no discernible AARD, corroborating previously noted

lack of predictive value of ANA testing.

Wednesday, November 10, 2010, 9:00 am

http://www.abstracts2view.com/acr/search.php?search=do & intMaxHits=10 & where= & ando\

rnot= & query=1845 & condition=PUBNUMBER

Not an MD

On Tue, Dec 14, 2010 at 8:30 AM, jane <janeatregis@...> wrote:

> The doc said her ANA titer and labs looked like lupus was a strong

possibility. she's going to a rheumy on monday, hubby is going with her. we have

a lot of people praying for her. thanks gina.

> jane

[Guest guest]

Jane,

Abuse of the ANA test is one of my pet peeves! Happens all the time.

The tacky sweater party sounds like a lot of fun and a good

distraction. I hope your daughter enjoyed it.

Not an MD

On Wed, Dec 15, 2010 at 4:25 PM, jane <janeatregis@...> wrote:

> Thanks so much for the words of encouragement. i copied that post and passed

it on to her at work, highlighting the really positive parts.

> her being the baby makes it harder on all of us.  she was enjoying a tacky

Christmas sweater party at her office this afternoon. I had found a pretty

over-the-top one at a thrift store for her a couple of weeks ago. can't wait to

see pics of the party.

> thanks again

> jane

[Guest guest]

I am so happy to hear that, Jane. What a relief.

Merry Christmas to you, Chas, and your entire family!

Not an MD

On Thu, Dec 23, 2010 at 9:30 AM, jane <janeatregis@...> wrote:

> , good news! Rheumy says it's not lupus, RA, or any other autoimmune

disorders at this point. YAY! they did a t-spine series and drew a ton of blood.

Chas said she asked the phlebotomist, " Are you sure you're allowed to take that

much blood out of me? " jokingly of course. the tech loved it. she goes back in

january for followup. her back is still hurting but the fatigue is a little

better.

> thanks for the good thoughts and wishes, and a happy Christmas to you and

yours.

> jane

[Guest guest]

You're so welcome, Jane. You and the group are very important to me.

Thank you,

On Thu, Dec 23, 2010 at 11:29 AM, jane <janeatregis@...> wrote:

> , thank you for keeping our happy little RA family together and going. You

mean so much to all of us.