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Thread: can you have pos ANA, neg ENA

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    Default can you have pos ANA, neg ENA

    After my initial flare they did some basic tests of and found my ANA was 1:640 with a nucleolar pattern, CRP/RF were all positive. I then had some ENA tests which were negative. My rheumie diagnosed me with lupus and I also had some further tests (which were done when I wasn't really flaring that much- but he wanted the tests before the plaquenil really kicked in) and dsDNA was found to be negative (it was tested earlier) as was all the other bits and pieces (antiphospholipid/lupus antibody, cryoglobulins, urine test for renal involvment and the rest were general markers). Although my ESR was raised in these tests (so don't know how much I was flaring).

    Could that mean that I may not have lupus and instead have a mixed connective tissue disease? I know my ANA pattern is more indicative of scleroderma and my ENA panel were all negative. I didn't think to ask my rheumie when he said that my dsDNA was negative and now I won't see him for 2 months!!! I know the outcomes are better in mixed connective tissue diseases and I am hoping!

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    ANA can be positive in Lupus as well as in other problems, such as rheumatoid arthritis or other types of problems in arthritis. Because the basic abnormality of lupus is an immune system that is in overdrive, most of the tests measure the degree to which the immune system is active.
    The ANA test is almost allway strongly positive in patients with lupus (still positive even when diluted more than 100 times, commonly expressed 1:100). However, many normal people also have positive tests, usually less strong (1:10-1:30). The "diffuse" and "speckled" patterns are common in lupus, but are also seen in other diseases and normal people. The "peripheral" pattern is relatively specific for lupus. The "nucleolar" does not often occur in lupus. A positive test means lupus is a possible, not difinitive, diagnosis.
    A negative test usually means that a patient does not have lupus, or that lupus is in remission. However, most patients in remission do not have negative ANAs.
    The anti-Sm antibody - Antibody to the Smith antigen is a protein that helps DNA stay in its correct shape as it goes about its business directing the cell how to do its work. Together, anti-Sm, anti-RNP, anti-Ro/SSA, and anti-La/SSB are known as ENA antigens. A positive test, like anti-DNA, generally means that lupus is present. False positive tests are very rare.
    However, a negative test does not mean that lupus is not present, since other tests can still be positive. Most persons with lupus have either anti-DNA or anti-Sm antibodies.
    Negative tests for both generally mean that lupus is not present.
    Have I answered your question? If not, let me know.

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    Its weird- I'm reading differing info on the nucleolar pattern. Some sites have said it is almost diagnostic for scleroderma and others have said that it is also for a few other things including lupus.
    My symptoms would support lupus as the cause- and that was how my rheumie thought.

    I assumed that my dsDNA would come up positive after the negative ENA. Could it be because I wasn't really flaring at the time? Do they get reported in a concentration too? The negative tests for both generally mean that lupus isn't present got me thinking- maybe it is a mixed connetive tissue disease. But I know a lot of those eventually settle on a diagnosis in a few years.

    On my ANA initial test results it also said that a nucleolar pattern is associated with sjogren's syndrome (nope), scleroderma (hmm) and SLE (symptoms favour) and that a high titre (over 1:160) is associated with systemic rheumatic disease- especially Lupus.

    So what you are saying is that with the negative anti-DNA or anti-Sm abs that lupus is not likely?? Is that even with my "not really flaring" during my anti-DNA test?

    Thanks as always

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    I just got some more tests back. ANA of 1:80 with an homogeneous pattern this time. dsDNA antibody was again negative. I have been on plaquenil for 4 months and the prednisilone for the previous month- would that make it go negative? I did have a reasonable flare before I went on the prednisilone, but it took care of it quite quickly after going on it.

    Could the higher ANA be a fluke? Can my titre go negative like that if I have lupus. I know you can have a negative ANA and still have lupus, but why would it go negative like that. I think I am back in a state of denial here about the whole lupus thing. Nothing seems to make sence..

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    Changing ANA manifested as seroconversion from a negative to positive ANA status, increasing titers, and changing antibody specificities can occur with certain treatments (especially Prednisone).
    The antinuclear antibody test is performed with different techniques in different laboratories; some techniques are more sensitive than others, such that one laboratory may find a (usually weak) positive test while another finds it negative. Some laboratories dilute 10-fold for screening (1:10), some as much as 100-fold (1:100), and some not at all. A commonly used method starts with a dilution of 1:10, then doubles with every successive dilution, so the next specimen tested is 1:20, then 1:40, 1:80, etc., the highest number positive being what the laboratory reports (for instance, 1:1280).
    Most lupus patients have sera that react at very high dilutions, essentially always more than 1:80, often more than 1:5120. Depending on the laboratory's reporting habits, a test that is positive at 1:10 or even 1:40 may be called either negative or weakly positive. Most laboratories count 1:80 and higher as clearly positive. The point is that ANA-negative does not always precisely mean completely negative. Another point is that speckled (as opposed to diffuse or peripheral) ANA patterns do not read well in automated immunofluorescence tests, so may be reported as lower titer or negative than they would be if they were hand read by an experienced technician
    As you can see, there are so many factors that could be causing the changes in your ANA titers. It might be beneficial if you ask your doctor about the negative ANA.
    I'm sorry I can't be more helpful to you, but the variables are too great and you should have a professional discuss your personal case with you. :cry:

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