posted
My sister's ANA levels were low. She now shows a negative ANA after being treated for malaria by her GP.
She is also positive for Epstein-Barr virus.
She is going to a LLMD now who is treating her for Lyme, but I am curious if LOW levels of antinuclear antibodies could also be an indication of the presence of Lyme.
The reason I ask is because I see a lot of people here tested positive for ANA - but those levels were high.
Thanks!
Posts: 24 | From Maryland | Registered: Aug 2007
| IP: Logged |
AliG
Frequent Contributor (1K+ posts)
Member # 9734
UpToDate performs a continuous review of over 375 journals and other resources. Updates are added as important new information is published.
The literature review for version 15.2 is current through May 2007; this topic was last changed on July 20, 2006. The next version of UpToDate (15.3) will be released in October 2007.
INTRODUCTION --
Testing for antinuclear antibodies (ANA) test is commonly used when evaluating patients who are suspected of having an autoimmune or connective tissue disorder.
Antibodies are proteins that are made as part of an immune response.
Large amounts of antibodies that have a shared target, such as one that is present in bacteria or viruses, are part of the normal immune response to infection.
When a person has an autoimmune disease, the body's immune system malfunctions.
One way in which autoimmune diseases cause illness is by producing large amounts of harmful substances called autoantibodies.
Autoantibodies, unlike normal antibodies that target bacteria, viruses, parasites, and fungi, attack the body's own tissues and cells.
Autoantibody-mediated inflammation and cell destruction can affect blood cells, skin, joints, kidneys, lungs, nervous system, and other organs of the body.
The ANA test identifies autoantibodies that target substances contained in the nucleus of cells.
Symptoms of autoimmune and connective tissue disorders vary from patient to patient and may be difficult to diagnose.
A positive ANA test, by itself, does not establish a diagnosis, but in combination with a particular patient's symptoms, a thorough physical examination, and other laboratory testing, a positive test result may help to establish a diagnosis.
ANA TESTING --
Healthcare providers use the results of an ANA test in several ways:
To aid in diagnosis of an autoimmune or connective tissue disorder
To rule out autoimmune or connective tissue disorders in patients who have only a few symptoms
To measure a patient's disease activity To determine the specific type of disease that affects the patient
DISEASES AND ANA RESULTS --
Patients with the following disorders or characteristics may have positive ANA tests:
Systemic lupus erythematosus (See "Patient information: Systemic lupus erythematosus (SLE)").
Scleroderma Mixed connective tissue disease Polymyositis/dermatomyositis (See "Patient information: Myositis and other inflammatory diseases of the muscle")
Rheumatoid arthritis (See "Patient information: Rheumatoid arthritis symptoms and diagnosis") Rheumatoid vasculitis (See "Patient information: Vasculitis")
Sj�gren's syndrome (See "Patient information: Sj�gren's syndrome")
Drug-induced lupus
Discoid lupus
Pauciarticular juvenile chronic arthritis
In addition, some patients with autoimmune diseases that affect the thyroid gland, liver, or lung (including Hashimoto's thyroiditis, Graves' disease, autoimmune hepatitis, primary biliary cirrhosis, primary autoimmune cholangitis, and idiopathic pulmonary arterial hypertension) may have positive ANA tests.
Certain chronic infectious diseases, such as mononucleosis, hepatitis C virus infection, subacute bacterial endocarditis, tuberculosis, lymphoproliferative diseases, and human immunodeficiency virus (HIV), may also produce a positive ANA test.
TYPES OF ANTINUCLEAR ANTIBODIES --
Certain types of antinuclear antibodies are somewhat specific to certain diseases or forms of diseases.
The main types of antinuclear antibodies include the following:
Antibodies to double-stranded DNA -- Patients with systemic lupus erythematosus or rheumatoid arthritis, or patients who have been exposed to drugs, including tumor necrosis factor alpha inhibitors (often used in the treatment of rheumatoid arthritis), may have moderate to high levels of antibodies to deoxyribonucleic acid (DNA).
Antibodies to histone proteins -- People with systemic lupus erythematosus or drug-induced lupus may make antibodies to certain histones, or protein molecules found in the cells of chromosomes that work with DNA to transfer genetic messages.
Antibodies to chromatin -- More than two-thirds of people with SLE have antibodies to chromatin, a mixture of nucleic acid and proteins in cells that contains genetic material and is stored in chromosomes. Anti-chromatin antibodies are especially prevalent in SLE patients with renal (kidney) disease.
ANA TESTING AND SYSTEMIC LUPUS ERYTHEMATOSUS --
In a patient with suspected systemic lupus erythematosus (SLE), the ANA test plays an important role in the diagnosis.
SLE is a chronic inflammatory disease that can affect many parts of the body, including the skin, joints, kidneys, lungs, nervous system, blood vessels, and immune system.
Because the severity and symptoms of SLE differ from patient to patient, laboratory tests -- including testing for antinuclear antibodies -- provide information that can be valuable in helping physicians make an SLE diagnosis.
The ANA test is considered the best diagnostic test for SLE, and it is typically performed whenever a doctor suspects a patient has SLE. (See "Patient information: Systemic lupus erythematosus (SLE)").
In patients with suspected or diagnosed systemic lupus erythematosus, additional testing may be performed to determine the presence of three specific types of antinuclear antibodies, including anti-DNA, anti-Smith (anti-Sm), and anti-ribonucleoprotein (anti-RNP) antibodies.
When positive, these tests are considered highly predictive of SLE.
Testing for anti-DNA antibodies may also alert clinicians to the possibility of disease activity in the kidneys. Some doctors monitor anti-DNA antibody levels.
INTERPRETING RESULTS --
If a person has antinuclear antibodies, they bind to the nuclei of the cells on the slide and produce a recognizable pattern when a stain is applied.
The number of times the blood must be diluted until the antibody can no longer be detected is known as the "titer"; this is a commonly used measure of the level of ANA present in the serum. Thus, a titer of 1:40 means after the serum is diluted more than 40-fold, the ANA is no longer detectable.
Both the titer and the staining pattern can help establish the diagnosis of autoimmune or connective tissue disorders. Certain illnesses may be associated with certain patterns of staining; however, the titer is considered the most relevant part of the ANA test. In general, the higher the titer, the more likely there is an associated disease present. Low titers of ANA are found in a large number of healthy persons.
To detect the presence of specific autoantibodies (such as antibodies to double-stranded DNA, individual histones, or chromatin), further testing is usually necessary for those with positive ANA tests.
A positive ANA --
A positive ANA test does not necessarily mean that the patient has lupus or another connective tissue disorders. As noted earlier, many healthy people may have a positive ANA test.
False positive results --
The ANA test is said to be false positive when a person tests positive but does not have any other features of autoimmune disease .
This situation occurs more often in women and elderly people. Certain medications, such as hydralazine, isoniazid, procainamide, and some anticonvulsant medications increase the chances of having a positive ANA test [1].
True positive results --
A healthcare provider may recommend that a patient who has pain and inflammation in multiple joints of the body, a strongly positive ANA, and a negative or low titer for rheumatoid factor undergo further ANA testing for specific autoantibodies (see "Types of antinuclear antibodies" above).
Depending on the symptoms that led to the ANA testing, further evaluation for one or more of the disorders that are associated with a positive ANA may be necessary (See "ANA testing" above).
WHERE TO GET MORE INFORMATION --
Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
Because no two patients are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.
This discussion will be updated as needed every four months on our web site (www.patients.uptodate.com).
Additional topics as well as selected discussions written for healthcare professionals are also available for those who would like more detailed information. Some of the most pertinent include:
Professional Level Information:
Measurement and clinical significance of antinuclear antibodies
Investigational biologic markers in the diagnosis and assessment of rheumatoid arthritis Diagnosis and differential diagnosis of systemic lupus erythematosus in adults
Miscellaneous antinuclear antibodies Significance of a positive ANA in young women with symmetric arthralgias
A number of web sites have information about medical problems and treatments, although it can be difficult to know which sites are reputable. Information provided by the National Institutes of Health, national medical societies and some other well-established organizations are often reliable sources of information, although the frequency with which they are updated is variable.
American Association for Clinical Chemistry (www.labtestsonline.org)
Arthritis Foundation (www.arthritis.org)
Lupus Foundation of America, Inc. (www.lupus.org)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (www.niams.nih.gov)
National Library of Medicine (www.nlm.nih.gov/medlineplus/healthtopics.html)
New York Online Access to Health (www.noah-health.org)
[1,2]
Use of UpToDate is subject to the Subscription and License Agreement.
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
| IP: Logged |
The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:
The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/
UBBFriend: Email this page to someone!
![[Smile]](smile.gif)
:
Printer-friendly view of this topic