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Old 04-21-2009, 06:55 PM   #1
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Question Different Titers, Confused

Hello everyone!

I have a question about titers. I had an ANA and the results read:
Normal range = Negative (at 1:40 Dilution)

I did a little research that indicated this:
Positive range (at 1:320 dilution) I read this at multiple sites .

My question is why the difference? I understand the difference with labs and values but would titers apply here? Why would they give different Positive/Neg. results? I am really confused. Can anyone help me with this? TIA for any information. FLFG
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Old 04-21-2009, 08:27 PM   #2
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Re: Different Titers, Confused

I had a positive and a negative test. I have so many symptoms. I did read on one sight that it is possible to have a positive and a negative and still have Lupus. I would be interested in knowing if others have any information regarding this.

 
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Old 04-22-2009, 04:36 AM   #3
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Re: Different Titers, Confused

FL FlowerGirl, I understand the ANA dilution test to work something like this.

First, a substance is added to the undiluted sample that will fluoresce *when in contact with certain autoantibodies* & create certain patterns. Bright fluorescent areas are microscopically visible *only if* such antibodies are present.

Next, some other subtance is carefully added in steps, each time doubling the sample volume; the goal is to count the # of dilutions needed to make the fluorescence disappear. After each addition, the overall sample is examined to see if any bright fluorescent areas are still visible. The LAST dilution at which fluorescent areas are seen = the test result. The more dilutions that are needed to make the fluorescent bright areas disappear, the higher the ANA result is.

I *think* the 1:40 result you cited means there were no fluorescent areas showing at a very early stage of the test, thus result = negative. But if something HAD still been showing, the next dilution would have been 1:80 (stop & check); then 1:160 (stop & check); 1:320 (stop & check); etc.

The other source you cited seems to be saying if fluorescence is still showing at the 1:320 step, result is considered "positive".

Obviously I'm just a patient, so please take what I write in that context! Sorry I didn't word this well, it's hard to find good words. Hopefully others here can chip in & rephrase! With my best wishes, Vee

 
Old 04-22-2009, 08:43 PM   #4
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Re: Different Titers, Confused

Hello--Thank you both so much.

I have a much better understanding now. Vee, I must say that you do such a terrific job at helping others here on this board. I think you worded your reply very well indeed. I am sorry that you have to be so experienced, but you are really good at this stuff. I thank you for sharing your time and experience with me. You are an angel........ FLFG
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Last edited by FLFLOWERGIRL; 04-22-2009 at 08:44 PM.

 
Old 04-23-2009, 06:21 AM   #5
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Re: Different Titers, Confused

FL FlowerGirl, hi. I just realized there's something more important to consider about ANA, beyond how dilution tests "kinda sorta" work!

Lupus comes in different "gradations" or "subsets", for lack of better words, and I *think* the odds of having positive ANA vary greatly across those groupings. My drs. speak in terms of these groupings, which seem to spring *loosely* out of rash types; but I note that *books & articles* don't seem to speak in these terms very often. (But please take with big grain of salt, because I'm only a dumb patient, OK? Plus, it's clear that for people who never get rashes, these groupings are not germane!)

1. discoid (DLE), meaning someone who has only cutaneous disease = scarring &/or depigmenting "discoid" lupus rashes, PLUS some non-life-threatening things like fatigue, joint pain, etc---meaning these patients initally meet fewer than 4 criteria. I *think* ANA is negative in this group, unless the patient is in a small subgroup that progresses to full-blown SLE.

2. subacute cutaneous (SCLE), meaning someone who presents with ONLY one type of rash = SCLE rash, either annular or psoriasiform. The range of problems possible in this group is actually the same as in SLE, *but* SCLE patients are believed to cluster on the milder end of the SLE spectrum. Many in this group meet 4 or more of the SLE criteria at time of Dx, but those tend to be the milder criteria. Anti-Ro is the autoantibody seen most often. But ANA isn't so clear-cut: it's positive in only roughly 70%. It's believed that in some people, anti-Ro actually "masks" the ANA findings.

3. SLE: here, as we've read & been told, ANA is "almost always" positive. The few cases where it *isn't* are seemingly the ANA-negative anti-Ro's described in group 2 above. Within SLE, doctors & medical checklist forms often use further subcategories like "subacute" (no major organ involvement) vs. "acute" (with major organ involvement).

My point is you can have some degree of lupus WITHOUT a positive ANA, like DLE-only; or be in that small group within SCLE who remains ANA-negative.

I fell into group 2 but remained ANA-negative, which TOTALLY confounded my local drs. They were SO SURE it couldn't be lupus. In marked contrast, my big-city drs. knew immediately what to test for, to get the needed proof.

What I took from my ridiculous experience: to keep trying, no matter what you're told by Dr. #1, 2, etc. BTW, thank you for your kind words. I'm so glad you're finding people here to talk with, at a time you really need company. I know how that feels---which is why I post here. So let us know how you're doing, OK? And hang tough! Warmest wishes, Vee

 
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