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Question for Dr V.
Lupylisa44 posted:
I read so many posts on this board where people who are initially diagnosed with lupus have a positive ANA then, when re-tested, their ANA is negative and their doctor wants to reverse the lupus diagnosis. Most of these patients are still symptomatic.

It has been my experience in the 28 years that I have had lupus, that my ANA has been negative on several occasions, but there has never been any doubt that I do, in fact, have lupus.

I know that there are many causes for a positive ANA, but does a negative ANA mean someone doesn't have lupus? Is there cause for these doctors to change their minds, or is it that many doctors just know so little about lupus, that they doubt their original dx?

It would be great if you could shed a little light on this for all of us.

With love, with patience and with faith, we'll make our way.
Lupylisa44 responded:
With love, with patience and with faith, we'll make our way.
Lupylisa44 replied to Lupylisa44's response:
bump up
With love, with patience and with faith, we'll make our way.
lisaisweavebee replied to Lupylisa44's response:
Bump up yet again
Lupylisa44 replied to lisaisweavebee's response:
bump up
With love, with patience and with faith, we'll make our way.
nancyj95 responded:
I recently had a negative ANA, and other normally positive lupus indicators were also negative. The rhuemy just laughed when I asked if I didn't have it anymore. I was feeling better than I had in a long time, so he just congratulated me on feeling better.
I am going next week to be evaluated by another doc and possibly participate in a new clinical trial-wish me luck!
R Swamy Venuturupalli, MD, FACR replied to nancyj95's response:
Excellent question. It has certainly come up several times in this forum. However, this is a controversial topic and I'm not sure I have a satisfactory answer.

Let me try to address the issues that you've raised.

Anti-nuclear antibodies are found in a variety of autoimmune diseases including RA, psoriasis, myositis, scleroderma etc. In lupus over 90% of patients have a positive ANA. A high titre of ANA over 1:160 is generally seen in lupus patients. Titres of 1:40 and 1:80 have been reported in about 30% and 14% of the general population respectively, i.e. patients without autoimmune disease (false positives).

They are usually measured using a technique called immunofluorescence (where a flouorescent dye is tagged to a standardized cell that been incubated with a patients serum). Based on how avidly the antibodies bind to the nucleus of standardized cell, titres are reported. The higher the titre, the greater the amount of anti-nuclear antibodies. This method of testing is the gold standard. There are newer methods of testing ANA's such as ELISA which have demonstrated accuracy comparable wit h the gold standard.

Occasionally, an ANA may be negative when tested by ELISA and positive when tested by immunofluorescence or another method.

Occasionally, patients with autoimmune disease have negative ANA's. In such situations, if doctors feels strongly that the patient has an autoimmune disease, a careful search for an autoimmune disease is conducted including looking for other antibodies such as anti-Ro etc.

Occasionally, the ANA tests turn negative especially with treatment.

In short, to answer your question, positive ANA titres are seen in most patients with lupus, occasionally they can turn negative with treatment, and rarely we see lupus patients with negative ANAs.
Lupylisa44 replied to R Swamy Venuturupalli, MD, FACR's response:
Thank you for your very informative answer! We really appreciate you taking the time to participate in this board!!!

With love, with patience and with faith, we'll make our way.
pennbird replied to R Swamy Venuturupalli, MD, FACR's response:
What if you have 1:160 ANA but the sed rate and CRP are normal?

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