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Life With Lupus

Smith Antibody Question


#1

Hello All!

I have been in a flare for the past 2 weeks. Extreme fatigue/weakness, both hands/arms really hurting as well as feet, and funky brain fog. (In the past I've had other symptoms, but this flare only the ones mentioned.) I had blood work done back in December which showed ANA positive, anemia, and high sed rate. The doctor had me go last week for further blood tests including tests that were not run the first time. I have the results in my hand but I don't see the doctor until tomorrow afternoon. This time results say:

ANA of 1:640 speckled and homogeneous

High sed rate

Anemic

Low C3 (normal range C4)

Negative for Native DNA Antibody

My question is on the Smith Antibody... it does not say "negative" or "positive". It just says the Extract Nuclear Antigen is 2. Does that mean there is something there?

Thank you for any answers I may get.

Sonja


#2

I found some information through Quest Dianostics. Wishing you the best as you find ways to find relief from this flare. Hugs. Carolyn

http://www.questdiagnostics.com/testcenter/BUOrderInfo.action?tc=9944F&labCode=QDV


#3

From Lupus Alliance of America

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Laboratory Tests
Posted in Lupus Info on 4/7/2010
There are 3 goals in using laboratory testing in Systemic Lupus Erythematosus (SLE):

Confirm a diagnosis of lupus in people whose clinical symptoms and signs suggest lupus. Laboratory tests are also helpful to distinguish lupus from other rheumatic diseases which may have similar symptoms and signs and to determine the extent of the organ involvement.
Monitor the effects of treatment on the course of lupus. Some laboratory tests improve as the person with lupus improves and worsen as the condition worsens (or even before there is a clinical flare).
Distinguish certain subsets of lupus. Some people with lupus develop clinical problems not seen in all lupus patients and these symptoms and signs may be associated with certain laboratory abnormalities.
Routine Clinical Tests

These tests are commonly obtained for the screening of many medical illnesses and are not specific to SLE or any other disease. They can help determine the degree of the disease activity (mild to severe) and the presence of inflammation in various organs (e.g. kidney disease). Abnormalities in these routine tests are not specific enough to be diagnostic of lupus, but they may be helpful in monitoring the effects of treatment.

Tests of Inflammation - Sedimentation Rate (ESR) and C-Reactive Protein (CRP)

The ESR and CRP tests detect inflammation in the body from any cause (e.g., active lupus, infection, heart attack). Unfortunately, in some people with active lupus, these tests are not very abnormal, so they are generally less helpful than in other inflammatory conditions, such as rheumatoid arthritis. Also, they are usually abnormal with infections, and cannot be used to distinguish a lupus flare from an infection in someone with lupus.

Complete Blood Count - Hemoglobin and Hematocrit (to detect anemia), White Blood Cell Count, Platelet Count

These tests are often abnormal in those with active SLE. Patients with any inflammatory disease can be anemic when they are sick. However, some people with active lupus develop a more severe anemia due to antibodies that directly attack and damage red blood cells (hemolytic anemia). Lupus is an illness which often causes a low white cell count or a low platelet count (seen in about 30% of patients). This can be a useful clue to the diagnosis of SLE in someone with multi-system conditions.

Urine Studies - Urinalysis and Urine for Protein

Everyone who has been newly diagnosed with SLE should have their urine tested. Kidney inflammation in lupus does not cause symptoms unless very severe or advanced. The presence of red blood cells and protein in the urine suggests active kidney inflammation from lupus (assuming there is no bladder or kidney infection).

Chemistry Panel - Liver Tests (AST, ALT), Kidney Tests (BUN, creatinine), Muscle Enzymes (CPK)

Liver tests may be abnormal in those with active SLE, especially if they are taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and others, for joint pain. These tests become normal when the lupus is treated. Abnormalities in the kidney tests suggest there is a reduction in kidney function which can be seen with acute kidney inflammation in lupus or with chronic kidney damage. Occasionally, muscle pain and weakness indicate muscle inflammation which will cause the CPK to be high. This will improve with treatment of the SLE.

Autoantibody Tests

The presence of auto antibodies proteins (antibodies) which react with our own body constituents (antigens) in the blood or in cells is the hallmark of SLE. The most characteristic of the auto antibodies are the antinuclear antibodies, which react with the constituents within the nuclei of all cells. The screening test for the presence of antinuclear antibodies is the fluorescent antinuclear antibody test (FANA or ANA). In general, these antibodies do not penetrate living cells so they are not necessarily directly damaging the tissues in those who have lupus. However, they are characteristic laboratory markers of SLE.

FANA Test or ANA – Antinuclear Antibody Test

This test is positive in almost all people with active lupus (99%) and is a useful screening test. If it is negative, it is unlikely that the patient, if ill and untreated, has lupus. On the other hand, the test is not specific for lupus and can be positive in other connective tissue diseases (such as scleroderma and dermatomyositis), in some liver and lung diseases, in patients taking certain medications (procainamide, hydralazine, isoniazid, etanercept, infliximab), in healthy relatives of lupus patients and in healthy elderly individuals. The specific constituents (antigens) in the nucleus to which the antibodies are directed (e.g. DNA, RNP, Sm, etc) are tested if the ANA is positive.

The titer (level) of the ANA (e.g. 1:640) is a measure of the amount of the antibody present. High titers make it more likely that the ANA is a true positive test (rather than a laboratory error or a borderline positive in a healthy individual - often positive up to a titer of 1:80). High titers can be seen in other conditions as well. A tier is specified as 1:160 or 1:320 or 1:640 etc. However, each dilution involves doubling the amount of test fluid, so the difference between 1:160 and 1:320 is only a single dilution. This does NOT necessarily represent a major difference in disease activity. The ANA titers go up and down during the course of the disease. It is not always possible to tell from the titer the severity of a person’s lupus.

The pattern of the ANA – homogenous (diffuse), speckled, peripheral (rim) – are generally not helpful except for the peripheral pattern which is seen almost exclusively in those with lupus.

Anti-DS (DoubleStranded) DNA Antibodies

DNA is the building block of the genes in the nucleus of all cells. Antibodies to DNA are characteristic of patients with SLE. The presence of anti-DNA antibodies is highly specific for the diagnosis of SLE and is rarely found in other conditions, although it can occasionally be seen in patients taking certain medications. Anti-DNA antibody titers may be useful to monitor patients with SLE because they often drop when the lupus is in remission and rise again if it flares. It should be noted however that only 70% of lupus patients make anti-DNA antibodies, so the diagnosis of SLE can be made even if the test is negative.

Anti-Sm (Smith) Antibodies

The presence of anti-Sm antibodies is highly diagnostic of SLE. Anti-Sm antibodies are found in only 30-40% of lupus patients and the diagnosis of SLE can be made even if the test is negative. Titer levels do not usually change with disease activity

Anti-Ro/SSA Antibodies

This antinuclear antibody is found in patients with Sjogren’s syndrome and SLE. It occurs in about 40% of lupus patients. Its importance lies in its associations with certain subsets of lupus patients. One association is with sun sensitive skin rashes that occur in patients with subacute cutaneous lupus erythematosus (SCLE). These rashes may be extensive and widespread, but unlike discoid lupus rashes, do not lead to scarring. Anti-Ro/SSA is also associated with a condition known as the neonatal lupus syndrome. Mothers with anti-Ro/SSA antibodies (whether they have lupus, Sjogren’s syndrome, or no connective tissue disease) can have babies who temporarily develop photosensitive skin rashes or who are born with a congenital heart block (a slow heart rate). This is a rare condition.

Anti-Histone Antibodies

Anti-histone antibodies are seen in 60% of patients with SLE. They are also found in 90% of individuals with lupus caused by certain drugs such as procainamide and hydralazine.

Antibodies to Phospholipids (APL) - Lupus Anticoagulant, Anti-Cardiolipin Antibodies, False Positive VDRL Test (test for syphilis)

Anti-phospholipid antibodies are directed against phospholipid antigens on platelets and other cells. They are not antinuclear antibodies and thus may be present in patients with a negative FANA test. Even though the name lupus anticoagulant sounds as though these antibodies might “thin the blood”, the presence of APL is associated with thrombosis (blood clots), not thin blood. APL may be found in 40% of lupus patients and in patients with other connective tissue diseases or in individuals with no other illness. These antibodies can occur in lupus patients even when the lupus is not clinically active or they can be associated with a number of serious clinical problems. These include recurrent miscarriages in pregnant women, mainly in the middle trimester; venous clots leading to thrombophlebitis and pulmonary embolism; arterial clots leading to strokes or gangrene.

Other Autoantibodies

There are other autoantibodies in SLE. Antibodies to ribonucleoprotein (RNP) are common but these are not diagnostically helpful because they are found in other diseases. Antibodies to ribosomal P proteins have been found in the blood of patients with neuropsychiatric lupus (brain involvement). A newly approved test, antibodies to SR proteins, is positive in 50-70% of lupus patients.

Complement Levels

The complement system is important in immune reactions. When lupus is active, complement protein levels often drop. The most common complement proteins that are measured are the third (C3) and fourth (C4). Low C3 and/or C4 levels are common in active lupus and are of value in diagnosing SLE and in following response to drug treatment. Low complement levels are very common in lupus nephritis (kidney inflammation). They generally improve or return to normal as the kidney disease improves with medication.

Other Tests

There are other tests which are not considered laboratory tests, but which are also helpful in the diagnosis of SLE and discoid lupus and in determining the extent and severity of organ involvement. These include skin and kidney biopsies, x-rays, spinal taps, and echocardiograms depending on the clinical features of the patients.

Summary

Patients with clinical symptoms and signs of a multi-system illness should undergo routine laboratory testing and testing for autoantibodies and complement levels, which can confirm the diagnosis of SLE with high accuracy. Furthermore, in known lupus patients, these tests can help define subtypes of SLE with unique clinical problems and can be useful in monitoring disease activity. The discovery of the usefulness of these tests has markedly improved our ability to diagnose and treat lupus patients.

Lupus America’s Least Known Major Disease
LABORATORY TESTS FOR LUPUS
ARTHUR WEINSTEIN, M.D.
Assoc. Chairman (Research)
Department of Medicine
Director of Rheumatology
Washington Hospital Center
Professor of Medicine
Georgetown University Medical Center
VASILEIOS KYTTARIS, M.D.
Fellow, Section of Rheumatology
Washington Hospital Center


#4

This is probably the best description of lab values I have ever found. Thank you


#5

VERY HELPFUL!!! Thank you so much.


#6

Thank you so much, Carolyn.


#7

My daughter Jackie has SLE and Vasculitis. She gets treated at the University of Michigan and Mayo Clinic in Rochester, MN. I try to support Lupus patients and find out more about the disease and how to treat it. Keep fighting the fight! Much love to all!


#8

Thank you Carolyn for the wonderful links you have shared, the information is very helpful. I wish Jackie all the best! :slight_smile:
~Sonja


#9

Sonja - Thank you. Jackie spent about 1.5 years bedridden due to fevers up to 105. Her case is unusual. Mayo Clinic tested her IL(Interluken) 6 level in 2009. When a new IL6 Inhibitor drug (Actemra) came out in January 2010, she got her first dose in February 2010. The high fevers stopped after she started using that drug. Mayo Clinic wrote a White Paper about Jackie's treatment because her case was so tough and this treatment worked for her. I pray for all of you that you are able to calm the Lupus flares and be happy. Carolyn


#10

My heart goes out to you and Jackie, Carolyn. It is bad enough to have a disease but even more difficult is to watch your child suffer. I have a son who has been fighting since February to get into Mayo. He has a doctor that wants him to get in but does nothing to help him and no other doctor will get involved. Finally he got a phone interview only to be told that he was triaged into the wrong clinic!!! And no that clinic is unable to process him into Internal Medicine where he needs to begin. He has a possibility of two different problems but no one in the area that he lives will confirm or deny. His job is in jeopardy and the family is suffering from loss of income. He has bosses that are fighting for him and know the mess he is in and even HR is battling for him. He metabolizes most drugs very, very fast and it takes up to 5 to 7 times the normal amount of anesthesia or pain medication to affect him. They think he has Ehler's Donlo also but again the doctors in Illinois won't help him. He is 40 and walks like an old man and is suffering a huge amount of pain. He works 4 hours a day right now and can not stand to sit for more then 5 minutes at a time. He is a lower VP in the chain of command at a large company. He is very lucky that he has worked there for 20 years, is known to be a good worker, great boss, and is well liked but there is only so much that can be done for him. My husband's life was saved at Mayo so we have high regard for it so no blame is placed there but....

Sorry, I don't know why I went into this except I really understand how this must be so hard for you. You and Jackie will be in my thoughts and prayers. Reet


#11

Jackie's Dr. at Mayo Clinic in Rochester is Dr. Clement Michet . Perhaps he would see your son. The other Dr. that she saw for her skin was Dr. Piddlekow. Jackie sees Dr. McCune at the University of Michigan in Ann Arbor. Perhaps you could try to see Dr. Michet to get started. He is an Internal Medicine Dr. and very good. http://www.mayoclinic.org/bio/10263268.html. I cherish every moment with my daughter. We have surfed some big waves and seem to on top of the wave right now. You can say that Jackie's Mom referred your son to him. Dr. Michet was the Dr. that wrote the white paper about Jackie. Best of luck!! Keep the faith!


#12

Thank you, Carolyn. I just sent my son the info. I never thought Jackie would be seeing someone like this when I wrote it so I guess I now know what led me to telling Jeff's story.


#13

Thanks a lot for those details.
Hope Jackie is doing well now. Best wishes to him.

Karthik


#14

Thanks! Jackie is doing very well! She is in a drug-induced remission. During "Lupus Awareness" in May, she rode a bike 100 miles with friends and raised nearly $7000 for Lupus Research. She told her story for the first time and her fundraiser was in local newspapers and on t.v. in the Lansing, MI area. She is a leader for a Lupus Alliance of Michigan Support Group. I'm very proud of her for living well daily with a very tough disease! Best of luck to you Karthik!

Carolyn


#15

It is wonderful to read such a positive story, Carolyn. I hope Jackie continues remission! Reet


#16

Thank you! We are grateful! Three years ago Jackie could not walk, had lost all of her hair, had red blotches all over her body, was hospitalized numerous times with 105 fevers and low blood pressue and as a result, lost 50% of the blood flow in her calves. The arteries in her calves are scarred from the vasculits. Jackie eats Gluten Free, Vegan and exercises. It is a miracle that she can do what she does. Her spirit is gigantic and she lives every moment. :)

Carolyn


#17

I watched the video of Jackie’s ride yesterday and it was awesome!!! :smiley: I will keep her and Jeff in my prayers.


#18

Thank you, Sonia. That is such a comfort to have others praying with you. Reet


#19

Thank You!


#20

Thank you so much for sharing this.