Conflicting ANA results

[cmc2121]

I have received conflicting ANA results from two separate tests.  One test was was an immunofluorescence assay and yielded a 1:160 positive ANA titer.  Following the positive titer, my doctor ordered the autoimmune cascade.  This second test (blood drawn only 2 days later) was done via enzyme immunoassay at a different lab.  The result was a value of 0.2, indicating a negative ANA result and thus automatically stopping any further testing in the cascade.  These are two very different test results.  From what I have read in the literature, the two methods commonly yield similar results, so I am very confused as to why they are so different.  However, I have also read that different laboratories can yield conflicting results (Abeles et al 2016).  Upon seeing the second test result, my doctor immediately reversed her opinion and decided that I do not have a connective tissue disease.

I'm a 27 year old female, with several years of symptoms that line up with a connective tissue disease.  I have joint pain that comes and goes (knees, ankles, lower back/sacroiliac area, elbows, wrists, hands; back pain in particular lasts for months with no relief during that time period), severe fatigue, skin rashes, and I get sick frequently & tend to stay sick for a long time.  I literally cried when she told me the second test came back negative, because after years of searching and struggling with these symptoms I finally thought I had an answer.  I still asked her to refer me to a rheumatologist, but she thinks that they are going to just show me the door out because my second test was negative.  These symptoms are severely impacting my life, and all I want is an answer.  I am at my wit's end.

Has anyone else had conflicting lab results for ANA?  What did you and/or your doctor conclude?  Thanks.

[Ohheyerikaa]

Keep your chin up dear.  I'm literally I  the same boat as you.  I've done so much research i should become a md at this point. The biggest thing i can say is your not alone, the scariest statement I've seen so far is that "it takes between 3-8 doctors and roughly 5 to 10 years to get a diagnosis and often we are labeled as chronic complainers during the early stages. That's not fair. But just don't stop trying! Push your doctor's, become informed and do your research and don't take no for an answer. It's so draining to be told your crazy when you know something is wrong, but you have to keep pushing for yourself.

[cmc2121]

Yes, that's precisely the worst part--being labelled as crazy.  Most doctors just go tell me to see a counselor. If I was making this stuff up, believe me that I wouldn't be sitting at home alone cringing in pain or pushing through painful work activities while keeping my lips zipped on the job.  What reason would there be to make it up?  Attention?  I have social anxiety--I hate attention. I also have bad anxiety about doctors.  I would not be going to a doctor if I didn't think something was seriously wrong.  I don't even have support from my fiance... he even asked me on the phone the other night if my pain was psychosomatic.  That was extremely hurtful.  Sigh.  I hope you keep pushing and find an answer as well.

[Red_Star]

IFA (indirect immunofluorescence assay) is the gold standard for ANA testing. In medicine, the gold standard refers to a diagnostic test or benchmark that is the best available under reasonable conditions.

[cmc2121]

So in theory, the doctor should not be putting so much weight in the EIA test, if the IFA is the gold standard. She seemed to favor the 2nd result because the test is "less subjective".  I feel like a good doctor would be pushing for further investigation, not voiding the results of the first test based entirely on the 2nd, done at a commercial laboratory.  What's the harm in further investigation?  Especially since I am running out of time with my insurance, which is amazing and covers almost everything in full.  Sadly, she's the only doctor who has even taken me seriously up to this point--everyone else has written me off immediately because I'm young, physically fit, and have a history of anxiety/depression.

[Red_Star]

A good rheumatologist would suggest trialing a drug (eg: Plaquenil) to see if this helps with symptoms. Mine did and he was the best doctor I've ever seen. :)

[cmc2121]

I'm taking meloxicam (mobic). Not prescribed by this doctor, but prescribed about a year ago by another doctor when my back pain was completely debilitating. It doesn't help much with the back pain but it does seem to help a bit with the other joints.

[karajo]

Hi cmc.  I know it is very discouraging to say the least.  I had various elevated ANA. It was all over the place. No one paid attention until it got over 1:640. Then it was 1:2560. I was put on plquenil.  My rheumatologist passed away so I had to start all over again with a dr.  By this time my ANA was negative.  It was neg for many years. My ANA is possitive now as well as antihistone, CRP and dsDNA. I have been sick for 10 years and been diagnosed with fibromyalgia and connective tissue disease. It's been an emotional journey, but I've learned some things.  First thing, eat very healthy. It really does make a difference. I mean very healthy.  Lots of vegetables and fruit. No sugar... so forth. The second thing, don't stress. Don't allow yourself to get stressed out. That is a big trigger.  Thirdly, get plenty of rest.  (Are you sleeping derply?)  Lastly, laugh.  No joke. (Pun intended) The Bible says a merry heart does good like a medicine.  Allow yourself room to laugh and enjoy life.  Another thing is to try and avoid the sun. If you end up having lupus this will help you in the long run.  You could ask your dr to see if you are deficent in vitamin D.  Just getting your vitamin D at a good level will make you feel better.  

Various things can make you have a low ANA. Sometimes it's high because somekne else has an autoimmune disease.

I hope I have helped you a little.

[cmc2121]

I don't sleep well.  Even had a sleep study done because my partner told me that I snore & I frequently stop breathing in my sleep then wake up (I've also caught myself gasping for air on wake up).  I wake up with a headache almost every morning that sometimes lasts for half an hour, sometimes all day.  The only thing that the sleep study found was heightened spontaneous arousal for unknown reasons.  I eat well, and supplement my diet appropriately, and all of my standard bloodwork is normal.  I stress. A lot, as I have had anxiety problems my entire life. I move frequently so it's really hard to find a doctor who will prescribe me the only medication that has helped (in the benzo class).  I work outdoors, so staying out of the sun is not an option, but I don't really fit diagnostic criteria for lupus so I don't suspect that is the problem.

[Red_Star]

I had sleep apnea as well (walking up gasping for air is not fun!). I had that symptom due to untreated hypothyroidism.

[cmc2121]

Interesting, I didn't know it could be caused by other conditions.  My thyroid levels are normal, so that's not the cause here.