ANA Test: What does it mean?

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ANA Test: What does it mean?

Titers

Stain Patterns

Antinuclear antibody

(ANA) test:

ANA stands for Antinuclear Antibody. This literally means

'substance against the cell nucleus'. The nucleus is the 'headquarters' of the

living cell, therefore the ANA can damage or destroy

cells and tissues. If the ANA destroys the nucleus of the cell, the cell dies.

If enough cells die, then the organ tissue dies.

One lab test will not be enough because of the systemic

nature of lupus. Systemic Lupus Erythematosus (SLE)

can affect many systems, or parts, of the body. The auto-antibody blood tests

are the most helpful for diagnosing lupus. As an autoimmune disease, lupus

causes the body to attack itself. The test causing the most concern and

frustration to the patient, is the Antinuclear

antibody (ANA) test.

The ANA (anti-nuclear antibodies) blood test is one of

the ruling factors in diagnosing Lupus, but it is not the only test that is

considered when diagnosing Lupus. A person can have a positive ANA and NOT have

Lupus. A person can have a negative ANA and still have all the other clinical

symptoms of Lupus. Some medications, infections, and other diseases can cause

the test to be positive. A positive ANA is just one piece of the diagnosis

puzzle. Other auto-antibody tests are more specific to lupus.

Getting a diagnosis of lupus can take weeks, or even

years. The clinical history is most important. That's why it's so important

that your doctor is a rheumatologist familiar with treating lupus. It is

important you keep a record of your symptoms, so

you can tell the doctor what has been going on.

To diagnose lupus, the physician has to look very

carefully at the titer (number) and pattern of the ANA test. The pattern of the

cell is the determining factor in whether the diagnosis will be Lupus,

arthritis, polymyositis, scleroderma,

or another connective tissue disease.

What's

all this talk about titers?

The titer shows how many times the technician had to mix

fluid from the patient's blood to get a sample free of ANAs.

Thus a titer of 1:640 shows a greater concentration of ANA than 1:320 or 1:160,

since it took 640 dilutions of the plasma before ANA was no longer detected.

A negative ANA is any number LESS than 1:80 (this is

" pronounced " one to 80 parts). (Plasma was diluted 1 part plasma with

8 parts diluting solution.)

Since each dilution involves doubling the amount of test

fluid, it is not surprising that titers increase rapidly. In fact, the

difference between titers of 1:160 and 1:320 is only a single dilution. And it

doesn't necessarily represent a major difference in disease activity.

Lower than 1:20 is considered a negative result.

1:80 is considered a

" low positive " and more tests should be ordered. 95% of people with

1:80 ANA do not have Lupus.

1:16 is considered positive and if SED

rates and Complement tests are positive, Lupus is considered.

1:32 is a definite positive and mean

the disease is active.

1:64 is considered very high

and tissue damage is imminent.

Q1. My question is " What is

considered a high ANA titer for lupus? My blood work will say 'Titers of 1:160

and greater should be considered highly suggestive of connective tissue

disease'. But my ANA's sometimes are 1:160 and 1:320

and then last time it was less than 1:40.

A1. ANA reports

include a titer (number) and a pattern. The titer tells us how many times the

technician had to dilute plasma from the patient's blood to get a sample free

of the anti-nuclear antibodies.

Thus, a titer of 1:640

shows a greater concentration of anti-nuclear antibodies than a titer of 1:320

or 1:160. ANA titers go up and down during the course of the disease,

and a high or low titer does not necessarily mean the disease is more or less

active. A titer above 1:80 is usually considered positive for lupus.

What Does

the Stain Pattern Mean?

The cells are also examined to determine the pattern of the

nucleus. Following is a chart indicating which pattern is associated with which

disease or syndrome:

1. Rim Pattern

A.

Systemic Lupus Erythematosus (Most Specific)

2. Homogenous Pattern

A.

Systemic Lupus Erythematosus (Very specific)

B. Tests

for Further evaluation

1. Anti-dsDNA

2. Anti-ssDNA

3. Anti-

3. Speckled Pattern

A. Most

common, least specific

B.

Disorders Indicated

1. Systemic Lupus Erythematosus

2. Mixed

Connective Tissue Disease

3. Scleroderma

4. Sjogren's

Syndrome

C. Tests for Further evaluation

1. Antibody (Anti-)

2. Ribonucleoprotein Antibody (Anti-RNP)

3. Scl-70

kD kinetochore

(Anti-Topoisomerase I)

4. Anti-La (Anti-SSB)

4. Nucleolar Pattern

A.

Disorders

1. Scleroderma

2. CREST syndrome

B. Further evaluation

1. Scl-70 kD kinetochore

(Anti-Topoisomerase I)

2. PM-1

5. Diffuse Pattern

A.

Non-specific pattern

6. Centromere Pattern

A. Seen in

PSS with CREST syndrome

Q2. My rheumatologist doesn't help

much because he goes a lot by whether my sed or

sedimentation, rate is elevated and other factors. I always have ANA titers in

speckled pattern - do not know what that is either?

A2. The pattern of

the ANA test can sometimes be helpful in determining which autoimmune disease

is present and which treatment program is appropriate. The speckled pattern is

found in SLE and other connective tissue diseases, while the peripheral or rim

pattern is found almost exclusively in SLE. Because the ANA is positive in so

many conditions, the results of the ANA test have to be interpreted in light of

the patient's medical history, as well as his or her clinical symptoms. Thus a

positive ANA alone is NEVER enough to diagnose lupus. On the other hand, a

negative ANA argues against lupus, but does not rule the disease out

completely.

Remember the big picture in the process of diagnosing

Lupus.

Diagnostic tools include:

· Medical history

· Complete physical examination

· Laboratory tests:

· Complete blood count Erythrocyte sedimentation rate (ESR) - an

elevated ESR indicates inflammation in the body

· Urinalysis

· Blood chemistries Complement levels - often low in people with

lupus, especially during a flare

· Antinuclear antibody test (ANA) - positive in most lupus patients,

but a positive ANA test can have other causes.

· Other auto-antibody tests (anti-DNA, anti-Sm,

anti-RNP, anti-Ro [sSA], anti- La [sSB]):

· One

or more of these tests may be positive in some people with lupus Syphilis test

- may be falsely positive in people with lupus

· Skin or kidney biopsy

Getting a diagnosis of lupus

can be a pain-staking process. However, sometimes isn't it just better to know?

Symptoms are managed for many with anti-inflammatory medications, and drugs to

dampen down the immune system, like Plaquenil. Your

doctor may want a definite diagnosis before proceeding with the treatment.

Lupus is no longer a death sentence.

From: Laboratory Tests Used in the Diagnosis of Lupus

Reichlin, M.D., Professor of Medicine and

Chief, Immunology Section, University of Oklahoma Health Sciences Center,

Oklahoma City, OK. Published by the Lupus Foundation of America.

Hugs,

Deanna

LUPUS Serenity

Prayer...

Lord, grant me the serenity to accept the things I cannot

change, the courage to change the things I can, and the wisdom to hide the

bodies of doctors I shot when they said, You're perfectly healthy, it's all in

your head "