Lupus: Support and Survival


ANA Test: What does it mean?
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-Smith

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. Smith Antibody (Anti-Smith)
         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 Morris 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.

    Contact the Lupus Foundation of America or the local Chapter that serves your area for more information about lupus, or the programs and services the LFA offers including support group information and physician referral.

    Lupus Foundation of America., Inc.
    1300 Piccard Drive, Suite 200
    Rockville, MD 20850-4303
    301-670-9292  800-558-0121

    Information gathered from :

    Searching for ways to deal with the depression, the frustrations, the questions about lupus, I joined a support group online.  LUPIES has been a wonderful gift.  I have learned more from the information I found on the support web site from other sufferers of Lupus than I did from my doctor.
    Thank you fellow Lupies!    May your days be pain free!

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