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Arthritis and Rheumatism

What Does Getting Two Different ANA Titers Results Indicate?

01/14/2008

Question:

I received ANA results of 1:160 H in 1998 at the age of 34 and the test again in 2002 with the results of 1:80 with an atypical speckled pattern. How could I have two different types of patterns? I know normal ranges vary from lab to lab. My grandmother had Lupus and my mother was diagnosed with Sjogren`s. I`m going for my annual physical next month. Should I ask my physician to repeat the tests and perform additional tests?

Answer:

You report an antinuclear antibody (ANA) test of 1:160 H in 1998. I am not sure if the "H" refers to High or Homogenous. Assuming that it means homogenous, that brings up the point of patterns seen on ANA tests. The patterns refers to the distribution of flourescence that is seen within the cell nucleus when performing an ANA assay. Examples of patterns reported are homogenous, speckled, rim, nucleolar, and centromere. Historically, different patterns have had different clinical associations. For instance, a rim pattern might be more likely to be found in systemic lupus erythematosus while a centromere pattern is more commonly found in limited scleroderma.

Unfortunately, the patterns do not have complete specificity for any one disease. One reason is that the pattern interpretation is subjective and may be prone to different reporting depending on the reader, particularly when the flourescence is not very clear. What one reader may interpret as a homogenous pattern, another reporter may feel is an atypical speckled pattern. Variability in pattern display may also depend on the cell line used to perform an ANA. While HEp-2 cell lines are most commonly used, other cell lines certainly exist and are in commercial use.

Instead of relying on patterns, most Rheumatologists now rely on antibody testing to find a specific nuclear antigen that is the source of the flourescence pattern. For instance, instead of relying on a homogenous pattern that is prone to nonspecificity and reader variability, one can identify the presence of a histone antibody. For this reason, ANA patterns are becoming more historical and less powerful for use in interpreting disease.

As you are likely aware, connective tissue diseases cannot be diagnosed with an ANA alone. If there are symptoms suggestive of a specific connective tissue disease, it is more elegant to test for targeted diagnostics rather than a general nonspecific battery of tests. Speak with your physician to see if further testing is appropriate based on your entire clinical picture.

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Response by:

Raymond  Hong, MD, MBA, FACR Raymond Hong, MD, MBA, FACR
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University