Scleroderma & Raynaud's UK (SRUK)
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ANA Blood tests - Question form a Newbie

Hello All,

I'm pleased to be part of the SRUK Community! Maybe someone has gone through what I'm experiencing?

I have Raynaud's and Coeliac disease. Recently, I have been experiencing acid reflux, muscular pain, dry eyes and trouble with the joints in my fingers.

I had a Anti nuclear blood test (indirect immunofluorescence) with a titer of 1.180 speckled and homogeneous.

When I went to my GP, He said I don’t have to do anything as many people have a positive ANA. The GP suggested doing the blood test again but this time it was an ELISA ANA and it came back negative.

My questions are, is the ELISA and IF ANA test the same? and are they the tests I should have to diagnose Scleroderma?

Thank you!

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Hi Catkins

My knowledge is pretty limited. But I think that the IFA test is regarded as the gold standard. But both tests (IFA and ELISA) can give false positives and false negatives.

In addition, you can of course have a positive ANA but still have no scleroderma.

I think the normal sequence would be to do the IFA again. If it is positive and indicates scleroderma then they would do the scleroderma specific tests. The main ones would be for scl 70, anti-centromere, and polymerase III. These together account for about 60% of scleroderma cases. But there are rarer cases with for example anti-tho/the (or soemthing like that).

But like I say you can be positive ANA and not have scleroderma. And about 8% of people with scleroderma are negative ANA.

Here is a link to a useful site which has info about sclroderma blood tests.

sclerodermainfo.org/

Hope thinsg turn out well for you.

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Hello! You must feel very confused with conflicting results. I had many, many blood tests over many years without a diagnosis until my scleroderma was finally diagnosed by biopsies. Stay positive, try again - things are improving all the time with big increases in the medical body of knowledge about autoimmune conditions. I wish you well.

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Hi, I'm fairly knowledgeable in this area, so maybe I can help. IFA is the preferred and far more accurate method of ANA testing. ELISA ANA tests result in a high rate of false negatives, as much as 40%, believe it or not. The IFA result you gave, however, isn't a possible titer, did you mean 1:80? The titers start at 1:40 and then strengthen at dilutions of 1:80, 1:160, 1:320, 1:640, etc. Some labs consider 1:40 and higher to be positive, and other labs consider 1:40 to be negative with 1:80 and above to be positive. Regardless, 1:40 and 1:80 are borderline or low positives. Titers can fluctuate one dilution in either direction from one test to the next as part of normal testing variability.

About 30% of the normal population (no symptoms) have an ANA of 1:40, so many doctors don't get concerned at that level. However, if symptoms are also present, that low positive ANA may well be significant. It's not uncommon for the titer to be a low positive very early in disease and later strengthen as symptoms more fully manifest, at which point it typically becomes quite stable and frequent retesting is not recommended.

Scleroderma can't be diagnosed by a blood test, it is a clinical diagnosis based on symptoms, that labs may support or contribute to. Raynaud's, joint pain, and reflux are common symptoms in systemic scleroderma, but may not be sufficient for diagnosis. Do you have any skin changes or swelling/puffiness of your fingers? If your ANA by IFA was 1:80 (please verify), there should be no need to retest that at this time, you can accept that as a very likely accurate low positive result. At this point you need individual scleroderma antibody testing. Ask your doctor to order anti-centromere and SCL-70 antibody tests as those are the most common scleroderma-associated antibodies. If those are negative you would move on to additional antibody testing. You would only be positive for one scleroderma antibody, as they are nearly always mutually exclusive.

Be aware that a GP and even most general rheumatologists will have little to no experience diagnosing and treating this extremely complex disease. If antibody tests are positive, you will need a referral to a scleroderma specialist early on. Here's a link to the official ACR/EULAR diagnostic criteria for scleroderma or systemic sclerosis that you may find useful. Best of luck to you and I hope you will keep us posted. catkins84

rheumtutor.com/2013-acreula...

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In my experience, a speckled ANA is consistent with Scleroderma. Mine was speckled and I have had systemic sclerosis for 17 yrs. Best of luck!!

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It can be, but a speckled pattern is not specific for SSc, it is seen in other conditions as well. However, staining patterns are considered to be unreliable because their interpretation is so subjective. Individual antibody testing is needed for confirmation. 😊

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Thanks for the advice everyone!

Dianekjs, I made an error before, my ana is 1:1280.

I do have swelling of my hands and feet, trouble bending my fingers, Reynolds, coeliac disease, anemia. Terrible fatigue is the most noticeable symptom. I'm underweight and 35 years old.

I'm really trying to rule out conditions. I was tested yesterday for SIBO as I have problems absorbing food and slow digestive transit. I understand that could be a symptom of systemic scerloderma.

I don't have any major skin conditions, just thick skin on my shins and tops of my feet.

I do feel like the GP doesn't really know what to do with me!

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