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Lupus

WHY LUPUS IF ANA TEST IS NEGATIVE

03/22/2001

Question:

I AM A 32 LATIN FEMALE. I HAD A DIAGNOSTIC OF FIBROMYALGIA, OSTEOARTRITIS IN HIPS, HANDS AND KNEES. FOR THE LAST TWO YEARS I AM SUFERRING OF HIGH BLOOD PRESSURE, MUSCULAR PAIN, MALAR RASH, SENSITIVITI TO SUN. MY REUMATOLOGIST THINK IS LUPUS BUT ANA TEST IS NEGATIVE, SED RATE IS POSITIVE 45. EIGHT MONTHS AGO I SUFFER A LEFT LEG DEEP VENOUS TROMBOSIS AND A PULMONARY EMBOLISIM. I GET A POSITIVE TEST FOR ANTICARDIOLIPIN . I AM IN COUMADIN FOR LIFE FOR THAT REASON I CAN HAVE A SPINAL TAP TO CHECK FOR LUPUS. LAST 3 MONTHS I RECEIVE AN ABNORMAL URINE 24 HOURS COLECTION TEST. EXCESIVE PROTEINE 325 AND CREATINE 285. REUMATOLOGIST SAID IS LUPUS BUT AGAIN LUPUS PANEL IS NEGATIVE. SHE PUT ME IN PREDNISONE 5MG. BUT URINE TEST CAME BACK THE SAME. I FEEL REALLY BAD AND I DONT WANT TO LOOSE THE FUNCTION OF MY KIDNEYS. HOW I CAN HAVE LUPUS IF THE TEST IS NEGATIVE. PLEASE HELP.

THANKS

Answer:

95-98% of persons with lupus have a positive test for ANA. Therefore, less than 5% of people can have a negative ANA test, and still have lupus. Therefore, persons having some symptoms and signs suggestive of lupus, but with a negative ANA test, should be very carefully evaluated for a large number of conditions that can have a positive ANA test. These conditions which can mimic lupus and have a positive ANA test include mixed connective tissue disease, undifferentiated connective tissue disease, scleroderma, myositis, rheumatoid arthritis and several others. Some times, it may take a while before a clear diagnosis can be made, because evolution of the disease may take some time.

Lupus patients who have a negative ANA test usually have a positive test for anti-Ro (also called anti-SSA) or anti-La (anti-SSB).

Back to your situation, the reason for your MD to have made the diagnosis of lupus may be the presence of `photosensitivity` with malar rash, which are quite uncommon in other lupus-like `sister` diseases, also called autoimmune diseases. Furthermore, presence of venous thrombosis with pulmonary embolism and a positive anticardiolipin (if it was `IgG` anti-cardiolipin and in high numbers such as 30 or more; other anticardiolipin - IgM and IgA - are not that important) usually suggests the presence of lupus or a lupus-like disease, called anti-phospholipid syndrome (APS).

Usually, spinal tap is not required to make the diagnosis of lupus. Some times, the tap is helpful in someone suspected of having brain or spinal cord involvement due to lupus.

The presence of 325 mg protein is abnormal, but still in the lower range of abnormality. I usually recommend a very careful urine microscopic examination for any red cells or red cell cast to detect involvement of kidney due to lupus or related disease. Also, it is very helpful to do some follow up urine tests.

I usually recommend my patients to get in touch with local `Lupus Foundation` or `Arthritis Foundation`; they can provide some booklets and give references to small lay language books on lupus and related diseases.

Today, lupus can be tackled - it does need careful attention, some minor life-style changes such as avoiding direct sunlight etc. I know many patients with lupus who are leading a highly productive and successful life. Best of luck as you learn more about this condition and take care of yourself.

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Response by:

Ram Raj   Singh, MD Ram Raj Singh, MD
Associate Professor of Clinical Medicine
College of Medicine
University of Cincinnati