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ANA patterns

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#1 amberjolie


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Posted 14 October 2009 - 11:17 AM

I was wondering recently. Since it's possible I might have Sjogren's (still waiting for a second opinion), I checked online at the symptoms, and they all seem to be what I'm currently experiencing (including the Raynaud's and esophageal issues). So my question would be (and I'll ask the rheumatologist when I see him in November): if I'm diagnosed with Sjogren's, how would I know it was both Scleroderma AND Sjogren's, and not just Sjogren's?

When I had my previous blood tests, although the ANA was quite high (1:640), I didn't have any other specific antibodies. BUT, the ANA pattern was speckled & nucleolar the first time, and nucleolar the second. Most websites I look at seem to indicate the nucleolar is pretty specific to scleroderma, but I've seen a couple that indicate it could still indicate Sjogren's.

Anyone have any info regarding ANA patterns?

#2 smac0719


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Posted 14 October 2009 - 01:10 PM

I don't know much about ANA, but my highest was also 1:640 and speckled. That along with a positive skin biopsy, tight skin, skin discoloration, chronic fatigue, rheumatoid arthritis led the dermatologist to diagnose me with scleroderma and send me to a sclero specialist. None of my other tests had been positive up to that point.
I may have Scleroderma, but Scleroderma doesn't have me!

#3 Jeannie McClelland

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Posted 14 October 2009 - 01:15 PM

Oh boy, the dreaded antibody question!

I guess the way I understand it is that antibodies, in the case of scleroderma, are a guideline, but not a make or break criteria. For instance some people test positive for Scl-70 and some don't (me). Raynaud's is one of the things on the tick-list of things adding up to a diagnosis of scleroderma, especially in the CREST form, but although an awful lot of us also have Sjögren's, it isn't necessary to have it to get a diagnosis of scleroderma.

That all sounds backwards to your question, doesn't it? Having the positive ANA in the patterns you've shown wouldn't rule out either Sjögrens or scleroderma. I have had the same patterns you have and have both Sjögren's and scleroderma~ So how would you know if it were both things and not 'just' Sjögren's? Well, you'd need to satisfy the rest of the diagnositic criteria for scleroderma. If you check out the page on What is Scleroderma? you'll find articles on diagnosis as well as the definition and characteristics of the different types.

Hmmm, clear as mud, right? Posted Image Sorry about that~

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#4 hippychik



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Posted 16 October 2009 - 02:45 AM

A year ago I was diagnosed with both lupus and scleroderma. I've had a low grade fever most days, a high fever many days- for 15 days straight recently, have skin rashes and peeling skin- like you get from a sunburn, tired, sore hands and feet and knees, etc. I've had my blood work done every three months and have been told my scleroderma tests were higher than my lupus tests. I went back last week as I've felt horrible for months- have chronic ear infection, dry mouth, etc. and all the tests came back negative including ANA. My doctor told me to keep taking the medicine and come back in two months. How does the ANA come back negative when in the past it has been so high and I feel horrible?

#5 Jeannie McClelland

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Posted 16 October 2009 - 03:59 AM

Hi Hippychick,

Just a guess here, but maybe the lab messed up on the ANA? I know the levels can go up and down and have been told that they don't necessarily reflect disease activity or how bad you are feeling.

You don't say what medicine you are taking. I don't think I would be willing to put up with high fevers without knowing exactly what's causing them. Did the doctor suggest you see your primary care physician?

I hope you will feel better soon.
Jeannie McClelland
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#6 sandra


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Posted 16 October 2009 - 04:11 AM

Hello Hippychick B)
Glad your here! My opinion is that bloodwork can change continually one time yes next time no, everyone is different, scleroderma is very complex, I have a permanent Lab card to have bloodwork monthly, sometimes blood looks good and the next month its off the chart! There are so many different tests (not blood alone) that can confirm a diagnosis. Maybe someone else can help your concerns better than me, I usually take advice, Glad you came here I am sure you will get answers soon.
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Stay in Touch, Sandra

#7 janey


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Posted 16 October 2009 - 05:00 AM

I'm with Jeannie - The dreaded Antibodies question! If you haven't seen our antibodies page, you might take a look at it. It has a lot of information that supports the first statements: "Specialized blood tests such as antinuclear antibody (ANA) tests are sometimes useful in the diagnosis or categorization of both localized and systemic scleroderma, as well as overlapping or other autoimmune diseases." The key words here "are sometimes useful".

On the antibodies for SSc page, we have a section devoted to ANA. The first link from MedicineNet.com might answer your question. It states "ANAs present different patterns depending on the staining of the cell nucleus in the laboratory... While these patterns are not specific for any one illness, certain illnesses can more frequently be associated with one pattern or another. For example, the nucleolar pattern is more commonly seen in the disease scleroderma. The speckled pattern is seen in many conditions and in persons who do not have any autoimmune disease. "

So I'll think you discover what many of have discovered, is that antibodies are a guide or suggestion that sometime may exists, but it is NOT a diagnosis. Hippychick pointed out the problem with antibodies going up and down - many of us have seen that happen a lot. Since antibodies are produced in response to a stimulus such as a bacterium, virus, or parasite, it would make since that they can change with time and circumstance. "Antinuclear antibodies (ANAs) are found in patients whose immune system is predisposed to cause inflammation against their own body tissues. " (MedicineNet.com) Based on that statement I would assume that the ANA can change as the amount of inflammation changes. Just a guess.

This is a great question for your Rheumatologist. Please share the answer with us. It comes up a lot here on the forum.

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