Positive ANA

[Rio04]

I am a 44 yr old male and approximately 7 months ago I went to my doctor with complaints of headaches and general fatigue.  She decided to run several blood tests in an attempt to isolate the fatigue and the first set of blood work came back with a positive ANA titer of 1:160 (homogeneous), C3 normal, RPR normal, C4 normal, ESR of 2, RF negative, CRP normal, RNP 56.  She was concerned that I may have early Lupus or MCTD and referred me to an Internist for further evaluation.  My Internist ran additional test 30 days later and my ANA titer was 1:320 still homogeneous, RF negative and remainder of tests negative.  I was not experiencing any joint pain or other major symptoms associated with Lupus or MCTD, no rashes, RP or dry mouth.  Although I have been diagnosed with GERD and a Hiatal Hernia.  My Internist referred me to Rheumotologist and he ran more specific tests looking for antibodies associated with several autoimmune diseases.  These test were conducted at a different lab and they all came back negative including the ANA.  Because I was not showing any improvement in my fatigue he ran another set of tests 45 days later with a 3rd lab and the results were all negative with the exception of ANA 1:160 homogeneous and a negative RNP.  I have seen some improvement in my fatigue over the past few weeks without being on any medication and am feeling better in general.  I have read that it is possible to have a positive ANA and not have an autoimmune disease.  My rheumotologist says that he does not believe that at this time I have an autoimmune disease and that it is possible that I carry a higher than normal titer.  Is it possible to have a positive ANA with no other tests being positive and not have a disease?

[Rhonda947]

A related discussion, ana,hyperparathyroidism,levels was started.

[laurab3397]

A related discussion, Healthy 25 year old female with UMCTD was started.

[RealMedicalTeaser]

I have a real teaser. I am a 26 year old white female. I am 5'5" and weigh about 130 lbs. I am pretty healthy with my life style....the occasional drink or two and I do not smoke. I have had high blood pressure for 8 years now and have been on medication, enalipril and HCTZ as needed, for almost 6 years. I suffer from Raynauds in the winter....very frustrating might I add. The cold football seasons in college were always fun but dreaded due to the "dead hands" as I called them. I have a positive ANA pattern which is speckled and I believe at 1:320. Also a homogenous pattern at the same level of  1:320 but only pops its head in every other year or so. EVERY definitive test for an auto immune disease was negative...negative lupus test...all negative! I was told it was some sort of "maybe" vascular problem since there was the issue with raynauds and high blood pressure. The high blood pressure medicine is an ace inhibitor meaning it dialates the vessels. Anyhow. Trust me, I love not having some text book disease, sure, but I want to know if I am missing something here. I do also have problems with my sciatica and also occasional knee pain with redness and swelling - this is very mild and not too often though. The best diagnosis I got was MCD, Mixed Connective Tissue Disease, which in the auto immune disease world means, "We don't know enough yet about auto immune diseases." Oh, I also suffer from some mild but undiagnosed endometreosis (sp) only because I dont want a scope down the belly button, this pain during the period DIRECTLY affects my sciatica as well. So much fun! Okay, I am done, PLEASE someone who has had similar symptoms email me or write on here. Any doctors willing to take a few moments to give their medical opinion would be greatly appreciated......although my hopes aren't high as NONE of the doctors I saw found anything definitive. No kidney, liver or heart problems, EKG was great as well as urine test. Thanks in advance for your help. XO, Lauren

[Alberts]

I have had several test run by rheumatologists the firs ANA I had was 1:80 with negative everyhing else, she diagnosed me with RA.  Becuase I had involvment in the joints of my hands.  One year later I awoke with my right knee is  hot, red and swollen beyond belief, my left knee has crackling when bending, my ankles are continuously swollen, my fingers hurt occasionally. I went back to se her this week she re-drew all my labs again, now my ANA is 1:160, but all others are normal again.  She put me on a medrol dose pack, that has helped with the swelling in my knee, but Im not any closer to a diagnosis.  I have a hard time believing I have RA with negative RA panals. The only thing positive is my ANA.  My urine had a few bacteria. What is your guess?  Oh about 1 month ago I awoke with my eyes like gravel in them and extremely red, I went to the eye specialist he said I was having some kind of irritation to my eyes???  Is this related?

[myproblem]

Is she planning to have the Hernia repaired soon? This could be one answer to her problems. If she still has trouble after the hernia is fixed, then it would be easy to see that there is an underlying problem.

[TTL]

She had a scope last year and he said the end of esophagus was irritated. She has pain when you press in her stomach where the hernia is at. She had a 2 radiologists that told her that her hernia had enlarged and need to be repaired.  I will have to ask the doctor if they gave her the about the sed-rate and anti-dna. Is there any more tests I should ask about for the autoimmune disease? Thank you for the information.

[myproblem]

As much as 1/3 of the general population do test positive for ANA. High ANA alone is not sufficient for a diagnosis. Diagnosis is made by blood tests, examination, medical history, and possibly imaging tests. A complete autoimmune panel is what she needs, including Anti-DNA, and SED-rate. Autoimmune diseases can cause Esophageal Dysmotility, which would fit her symptoms. A Hiatal Hernia can cause reflux, and chest pain. Has she had a scope of her esophagus?

http://www.mayoclinic.com/health/hiatal-hernia/DS00099
http://www.mayoclinic.com/health/search/search
http://www.emedicine.com/MED/topic740.htm

This link is to a site that lists about 80 different autoimmune diseases.
http://www.aarda.org/patient_information.php

[TTL]

My sister is having similiar symptoms to Gerd and she definitely has a Hiatal Hernia. We think the hernia is causing her problems(acid, heartburn, difficulty swallowing,chest pain, weight loss(because of not swallowing the food causing her to have nausea and vomit)if she eats slowly it works she can eat her food. Some doctors say that the hernia is not her problem and she has lupus. She does not have joint pain,fatigue,rashes etc. but she had a positive ANA. I know you have a positive ANA and not have the disease,but do any of the above symptoms she have sound like Lupus. Other doctors say it is her hernia causing her problem. This is confusing because nobody will give us an answer. Also could you tell me the name of the test they check to see if you have the disease? Thank you

[lusamo]

I have had Raynaud's for years and always showed a negative ANA. I had Hashimoto's 20 years ago and thyroid surgery. I'm in generally good health, but my recent blood work showed a positive ANA and elevated anti-centromere antibodies. My Rheumatologist says that I do not have sclerderma(my fear), but that it appears I'm on the road to Lupus.  I have never heard of these tests and am very frightened although my doc was not so. He did start me on Plaquenil which helped some of the arthritic pain?
Anybody able to help me understand?

[Kevin Pho, MD]

You have had a pretty comprehensive evaluation, including tests and evaluations by three physicians.  

Yes, it is possible to have a positive ANA level without the presence of rheumatological disease.

One study of normal individuals found an ANA titer above 1:40 in 32 percent, above 1:80 in 13 percent, and above 1:320 in three percent.  If there is an absence of specific autoantibodies (i.e. ds-DNA), then it is less likely that a rheumatological disease is present.

It is because of this false positive rate that ANA levels cannot be used as a screening test in the general population.

You can discuss these considerations with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b