How bad is 1/320 titer positive ANA?

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    The ANA is a laboratory test used when the differential diagnosis includes the possibility of drug-induced lupus, rheumatoid arthritis, systemic vasculitis, scleroderma, primary antiphospholipid syndrome, inflammatory myopathies, viral hepatitis, sarcoidosis, acute drug reactions, and systemic lupus erythematosus.

    In SLE, the following auto-antibodies can be seen with the following frequencies:

    ANA = 95–100%, anemia 60%, leukopenia 45%, thrombocytopenia 30%, Direct Coomb’s positive 30%, proteinuria 30%, hypocomplementemia 60%, anti-native DNA 50%, anti-Sm 20%.

    As well as the following anti-phospholipid antibodies:

    anti-cardiolipin Ab 25%, lupus anticoagulant 7%, and anti-β-2-glycoprotein 1 25%.

    A titer of 1: 320 is a measure of how many dilutions are required before the ANA antibodies are no longer detectable. In this case, the antibodies in the original specimen are high enough that it takes many dilutions before it is no longer detectable. The greater the number of dilutions required is a measure of the amount of auto-antibody present. The ANA test while very sensitive is not very specific as up to 20% of healthy adults have + ANA as well as in patients who have rheumatoid arthritis, autoimmune thyroid disease, scleroderma, and Sjögren syndrome.

    Most assuredly, the doctor will order additional blood work to button-down the diagnosis more precisely.

    Citation: Papadakis, Maxine A., et al. Current Medical Diagnosis & Treatment 2019. McGraw-Hill Education, 2019. pp. 854–855.

    Responses should be considered general in nature, and not specific to any one person; consequently, they are not to be construed as specific medical advice and do not create a doctor/patient relationship. For more specific advice unique to your particular situation, consult a local medical professional.


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    You feel like you’re getting worse from what? I am speaking here as someone who has tested positive on an ANA before and negative at other times. In and of itself it doesn’t have to mean much. First of all it has a range. You’re not just positive. It has a whole range of results from extremely mild, which means pretty much nothing, to severe, which is more likely to mean something. It is used as one of the tests in diagnosing autoimmune disorders, and sometimes healthy people test mildly positive. It also has an alarmingly high false positive rate meaning that many people who test positive, are NOT ANA positive.

    I have tested on the low end of positive on some occasions, probably because I have Rheumatoid Arthritis. At other times, I do not test positive. It is not diagnostic and probably does not mean anything.

    If you had Covid 19, it is not surprising that you were ANA positive. It probably has something to do with your body’s response to the inflammation in Covid. If you do not have any symptoms of an autoimmune disease now, then this is most likely just the result of the virus and you will be fine.

    The good news is that there is no emergency involved, and even if you had an autoimmune disease, there is no need to rush. Most of us with autoimmune disorders take years to be diagnosed, so don’t worry. Five months is not a long time in the world of autoimmune disorders, and they would need to wait to see if the ANA goes away over time anyway. Then they would need to do more tests.

    Most of us with autoimmune disorders have learned to go with the flow and understand that there are times when the disease is more active and other times when it is not. If you would like to learn more, call a rheumatologist, explain what the problem is, why you are feeling worse, and make an appointment. You might also call the office of the doctor who did the original blood test and ask them about the results. They may be able to explain what your results might mean and why waiting 5 months is not a serious problem.

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    An autoimmune disorder causes your immune system to attack your own cells, tissues, and/or organs by mistake. These disorders can cause serious health problems. An ANA test is used to help diagnose autoimmune disorders, including:

    • Systemic Lupus – erythematosus (SLE). This is the most common type of lupus, a chronic disease affecting multiple parts of the body, including the joints, blood vessels, kidneys, and brain.
    • Rheumatoid Arthritis a condition that causes pain and swelling of the joints, mostly in the hands and feet
    • Scleroderma a rare disease affecting the skin, joints, and blood vessels
    • Sjögren’s syndrome a rare disease affecting the body’s moisture-making glands

    Because it came back nonspecific, I would think it’s fibromyalgia. Are you in chronic pain? Any history of fibromyalgia in the family? I do not believe it’s stress or infection. Stress is hard to find in the blood and more associates with the heart. Infection is in the white blood count.

    A positive ANA test (which is a screening test ) along with positive Anti Ds DNA antibody (more specific for lupus) is most likely indicative of lupus. However a few cases of mixed connective tissue disorder also may show a positive ds DNA. However along with the antibodies, there should be associated clinical symptoms. Atleast 4 out of 11 criteria of the American College of Rheumatology (ACR) criteria should be present for a diagnosis of lupus.(Systemic Lupus Erythematosus (SLE)

    For testing more antibodies an ANA blot can be done, which tests for several different antibodies which may be seen in other autoimmune diseases. Since you are pregnant , there is definitely need for more caution and care considering you have been diagnosed as Lupus. Regular check ups with your physician and gynecologist is essential for an uncomplicated pregnancy. There may be some complications which are more likely to occur with pregnant mothers having lupus. Not to sound alarmist, but you need to keep an eye out for these following problems, so that you can tackle them in time if they occur.

    1. Hypertension in pregnancy: Lupus may be associated with high blood pressure (preeclampsia) during pregnancy in about 20% cases. This results in loss of protein through the urine and swelling all over the body and may hamper the blood supply to the placenta which nourishes the baby. When blood pressure remains uncontrolled, it may be required to deliver the baby before 37 weeks.
    2. Preterm delivery : There is an increased risk of delivering the baby before 37 weeks , in which case the baby may need additional support to thrive and survive as their development in the uterus may not be complete.This is more likely in women with preeclampsia, active lupus and antiphosphoplipid antibodies
    3. Lupus flares: Usually the symptoms of lupus reduce during pregnancy, but there might be cases where they flare up and may be needed to be treated with some low dose corticosteroids.
    4. Miscarriage: There is a higher risk of miscarriage particularly those with preeclampsia (high blood pressure), active lupus and antiphospholipid antibodies

    There may be more blood tests that the doctor may order like:

    Complete Blood count : to check your hemoglobin levels, total white blood count and platelet count

    Renal function tests: to check for amount of kidney damage , if any. Along with this a urine examination may be advised to check for any loss of protein through the urine.

    Anti phospholipid antibodies: to check for the risk of miscarriage.

    SSa and/or SSb antibodies: mothers with these antibodies may have babies affected with neonatal lupus (its not like adult lupus , but a different transient condition, with a risk of an abnormal heart rhythm in the child)

    anti ds DNA antibodies : to measure and keep a track of the disease activity

    Please ensure that your doctor is aware of all the medication you are taking for lupus. certain drugs like methotrexate, cyclophosphamide, mycophenolate mofetil, leflunomide and warfarin should be avoided during pregnancy.

    You’ve mentioned leukocytes in the urine , however you haven’t mentioned a number. Its usual to find 2–3 per high power field (hpf). If its not above 10, then theres less likelihood of a urine infection. Also, i assume there is no protein and blood in the urine , which is a good sign and your creatinine (used to measure renal function) is not above the normal values, which is again good sign. So, overal your kidney function seems fine .The MPV , UIBC and Rubella tests of yours don’t seem to be clinically significant.

    Its important to go for regular follow ups with your physician and gynecologist and they can help to towards an uncomplicated pregnancy and healthy baby.

    Wishing you all the best for your pregnancy! Take care and write back if you need any more information.

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    On what ground the ANA test was done,not mentioned here. ANA positive means your blood contains “anti-nuclear antibodies”ie.the presence of auto antibodies which do not indicate the presence of autoimmune diseases or a therapy is needed. Some medications can cause ANA positive result. Even in healthy individuals a positive reaction can be seen.


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    ANA is AntiNuclear Antibody and is a sensitive indicator of SLE. However, it is not very specific. Implying that it can be positive in a number of autoimmune conditions and even in some persons without any disease condition. A titre that you have mentioned means that it is positive to an extent where it can be considered significant. Sometimes, antibodies turn out positive but are usually near the cutoff and such results are considered equivocal. But a higher titre implies the significance of the rest result. This calls for further work up for a definitive diagnosis if there is presence of any symptoms. However, it might not be a good idea to chase an abnormal lab value if there are no symptoms.

    A speckled pattern in an anti-nuclear antibody (ANA) test may indicate Sjogren syndrome, scleroderma, polymyositis, rheumatoid arthritis, mixed connective tissue disease or systemic lupus


    I once had ANA between positive and negative, all other tests were negative, there was a low temperature of a little over 37 degrees for a year, and upon that one test between positive and negative, the doctor made a diagnosis of not less than rheumatoid arthritis.

    It was proved wrong ever since, because I never had it, what I had had at the time was probably a viral infection due to my lowered immunity because of the intense stress and sense of guilt that I had when I put my mother in a home for the senile people, with hard case of Alzheimer’s.


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