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Lupus

The Difference between Suspected and Sure

12/10/2000

Question:

Two years ago I had a lupus panel test it was negative, the positives were ANA 160, Neucleolar pattern, slight anemia, Positive RF and Positive Reactive Protein. Most recent test shown same Neucleolar pattern and ANA 360, WBC 14.1 (normal 4.to 11.0) and lots of other abnormal stuff. The labs indications are PSS or SLE. If my SLE panel comes back negative for C3, C4. etc., Can a person still have SLE? Or do you have to have the positive tests to confirm SLE? I ask this because this is what I suspect I have. My internist is trying to get a Rheumatologist close enough for me to travel that will except my Insurance. Also if SLE is diagnosed can a Internist adequately treat it or is a Rheumatologist necessary? I appreciate your thoughts on this.

Answer:

You will need to see a rheumatologist to get your problems sorted out.

Abnormal ANAs in a 1/160 pattern are occasionally seen in totally healthy individuals. Accordingly this test by itself does not tell you anything.

The American College of Rheumatology has a very sensitive and specific criteria for the diagnosis of SLE. If you have at least four of eleven items, the diagnosis is quite certain. A normal C3 &/or C4 does not exclude SLE.

As you mentioned, scleroderma is also associated with an abnormal ANA particularly nucleolar patterns. However, the diagnosis of this disease (like lupus) is determined primarily by certain abnormalities in the history and physical rather than laboratory tests.

For more information:

Go to the Lupus health topic, where you can:

Response by:

Larry   Houk, MD Larry Houk, MD
Professor of Clinical Medicine and Rheumatology
College of Medicine
University of Cincinnati