Antinuclear antibodies 1:40

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Antinuclear antibody tests measure the quantity and pattern of abnormal antibody that react against one’s own body tissue. Specifically, the antibodies that react to a cell's nucleus. Antibody directed against the self is called an auto-antibody. All people have a small amount of auto-antibody, but about 5% of people have a higher amount. About half of this 5% of people also have an autoimmune disease, such as systemic lupus erythematosus or rheumatoid arthritis. The ANA test by itself cannot make the diagnosis of a specific disease. It is used in combination with a patient's symptoms as well as the results of other laboratory tests.

The body's immune system normally attacks and destroys foreign substances such as bacteria and viruses. However, in autoimmune diseases, the immune system attacks and destroys the body's normal tissues. The immune system produces antibodies that attacks the body's own cells as though they were foreign leading to damage and destruction.

A test for antinuclear antibodies (ANA) is done to help diagnose conditions that include:

• Systemic lupus erythematosus (SLE).
• Rheumatoid arthritis.
• Sjögren's syndrome.
• Scleroderma.
• Hashimoto's thyroid disease.
• A possible medication reaction.

The results of an antinuclear antibody (ANA) test are expressed in what are called "titers". A titer is a measure of how much the blood sample can be diluted before antibodies can no longer be found. A titer of 1 to 80 (1:80) means that antibodies could be last detected when 1 part of the blood sample was diluted by 80 parts of saline (a dilute salt solution). A larger number indicates that the antibodies are present in greater concentration. For example, a titer of 1 to 320 indicates a higher concentration of antibodies in the blood than a titer of 1 to 80.

Generally, ANA titers of 1:40 and below are not considered significant. A high ANA titer may indicate the presence of systemic lupus erythematosus (SLE). Almost all people with SLE have a high ANA titer. Conversely, most people with a high ANA titer do not have SLE. Only about one-third of patients who are seen by a rheumatologist for high ANA titers are diagnosed with SLE. Other conditions may cause a high ANA titer. About 30% to 40% of people with rheumatoid arthritis also can have a high ANA titer.

Many other conditions may result in a high ANA titer. These conditions include scleroderma, Sjögren's disease, juvenile arthritis, and inflammatory muscle disease. Other conditions associated with a high ANA titer include Raynaud's syndrome, various viral infections, and liver disease. Although an ANA titer may help support a diagnosis of these problems, it is not used in isolation to confirm a diagnosis. A thorough medical history, physical examination, and other studies are needed to confirm a suspected autoimmune disease.

Some healthy people have high levels of antinuclear antibodies. For instance, some people with a family history of autoimmune disease may have a high ANA titer. The higher the titer, however, the more likely it is that the person has an autoimmune disease.

Factors that can interfere with the test and the accuracy of the results include many medicines such as hydralazine (Apresoline), procainamide (Procan, Pronestyl, Promine), and certain anticonvulsants (such as Dilantin, Mysoline). The type of lupus caused by these medicines is called drug-induced lupus. Lupus resulting from these medications may also have present with a high antinuclear antibody (ANA) titer.

Other medications that can cause a similar problem are antibiotics (isoniazid, penicillin, and tetracycline), birth control pills, lithium, and some diuretics, such as chlorthalidone (Hygroton), and heart or blood pressure medications, such as acebutolol (Sectral), captopril (Capoten), atenolol (Tenormin), metoprolol (Lopressor), lovastatin (Mevacor), and quinidine.

Some older individuals (5% to 40%) may have slightly elevated levels. Gender plays a role since older women appear to have higher ANA titers than older men.

Bottom line: SLE should not be diagnosed by the results of the ANA test alone.

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