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Includes Expert Content
Another question for Dr. v - anti ds- DNA / histone AB
lupycakes posted:

I'm staring at recent lab results trying to figure out the relationship between ds-DNA and histone AB. I know histone AB are seen in drug induced lupus but is it possible to have high (376) ds-DNA with drug induced lupus? Or is possible to have high histone AB with SLE? And how in the heck is it possible to have a normal ANA on the same blood test?? I'm beginning to think none of my lab work can be trusted... Sigh...

Any light you can shed on their relationship would be much appreciated!!

Lisa (aka cake lady )
R Swamy Venuturupalli, MD, FACR responded:
Anti-histoneantibodies can be seen in lupus. About 50% of lupus patients have antihistone antibodies. However, over 90% of patients with drug-induced lupus have antihistone antibodies. Having antihistone antibodies does not mean that you'll have drug-induced lupus, and they can certainly be seen in systemic lupus.[br>[br>In terms of the ANA being negative, while double strand DNA antibodies are positive, this is unlikely. It means, that the methodology being used by the laboratory to test the ANA, is faulty. In general, the best method of testing for an ANA is by immunofluorescence. However, I think that the ANA test being negative in your case, was a false negative. The double-stranded DNA antibodies and antihistamine antibodies are likely real.
lupycakes replied to R Swamy Venuturupalli, MD, FACR's response:
Thank you !

I've had more trouble with lab work over the years - even at the Cleveland Clinic - where on the same blood sample there would be inconsistencies like the above problem....sigh....I use to believe in test results, but not so much anymore.

Happy July 4th !

frootlupe72 replied to R Swamy Venuturupalli, MD, FACR's response:
I have a question for Dr. Venuturupalli. I have been symptomatic since since 2004 but several prior Lupus tests had come back negative. I had a very bad episode this past May and was diagnosed with SLE in June. (I was diagnosed with Seronegative RA just six months prior after testing negative for Lupus). In June my ANA came back positive. My Rheumatologist then did the Avise SLE Panel on me and here are my results:

ANA (ELISA): Positive (36 Units)
Anti-dsDNA: Positive (567 Units)
Anti-MCV: Negative (6 Units)
EC4D: Positive (14 Units)
BC4D: Negative (39 Units)

The rest of the tests...Sm, m, 70, Ro, La, sc, ce, jo, Mrf, Arf, Mcl, Gcl, Mb2, & Gb2 were all negative.

My questions are these...

#1-After so many years of searching for answers, how can I finally be sure that my Lupus diagnosis is correct? I have read many articles that say that positive bloodwork cannot give a definitive answer.

#2-In a nutshell, what is the purpose of the Avise SLE Panel & what, in laymen's terms is the interpretation of these results?

Thank you!
lupylisa44 replied to frootlupe72's response:
Hi Frootlupe This may help answer your question:

With love, with patience and with faith, we'll make our way.
R Swamy Venuturupalli, MD, FACR replied to frootlupe72's response:
I appreciate your asking this question, as it raises a relevant issue regarding diagnostic tests. As everyone who reads this board knows, diagnosing lupus is not an easy task as everyone presents with different manifestations and laboratory tests. So your story is not uncommon. Happily, we have made some progress in this direction and there are several "biomarkers" that are being studied to diagnose and monitor treatment of lupus. Biomarkers are lab tests or imaging tests that can show evidence of a disease process or disease activity.

In addition to the answer below about this specific test, I refer you to a previous post of mine, discussing different methods of measuring antibodies and incidences of false test results.

To specifically answer your questions:

1. You are right that we do not make the diagnosis of lupus based only on blood work. Typically, you need 4 criteria to make the diagnosis of lupus. The new SLICC clinical criteria for lupus from 2010 are highly specific. (good at predicting which people do not have the disease and those that have it) These criteria require that you have a total of 4 criteria to receive the diagnosis of lupus. Of these 4 criteria, at least one must be a clinical criteria (rash, arthritis etc) and at least one must be a lab criteria. (ANA, DNA etc) If you fulfill these criteria, assuming that other conditions presenting similary have been ruled out, (for example rheumatoid arthritis has been ruled out by negative tests and the clinical features and x ray/MRI features, or hepatitis infection has been ruled out) the likelihood that you have lupus is close to 90%.

2. The Avise SLE panel is a panel of 5 tests that are performed to diagnose lupus. The results of the 5 tests are analysed to create a composite score. If your score is above a certain threshold the Avise SLE test is considered to be positive. This "test" was literally put to the test in a large multi-center study of 593 patients. In this study, it was found that the sensitivity (the percentage of sick people who are correctly identified as having the condition) was 80% and the specificity (he percentage of healthy people who are correctly identified as not having the condition, sometimes called the true negative rate) was 87%. Thus, the Avise SLE test is a good test for diagnosing lupus and if positive the likelihood that you have lupus is quite high.

Hope this helps. Wishing you the best in your journey.
frootlupe72 replied to R Swamy Venuturupalli, MD, FACR's response:
Thank you so much for your answer which was immensely helpful. I have just a couple of more questions. If you could be so kind as to answer them I would be so grateful.

#1: What does the EC4D portion of the Avise SLE Test tell? Mine was Positive (14 Units)

#2: I was initially put on Plaquinel & Prednisone which rendered immediate and temporary results but it wasn't long before I had another major flare (2 weeks) so my doctor then added Methotrexate & Folic Acid and ramped down my Prednisone. I continue to have very bad flares about two weeks apart. My doctor has just taken me off of the Methotrexate and started me on Cellcept. I know little about Cellcept. Why is it usually perscribed for Lupus patients?

Thank you so much again...

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