positive ana and anti-scl-70

Question  I am a forty year old women normally in good health. I received a positive result on two separate ANA tests (1:2560, homogeneous), which is apparently quite high. Subtest scores were all negative except Anti-scl-70 (2.0), anti-SM (1.1). I went to the doctor for the following symptoms: fatigue, anxiety, nausea, cold flashes. These symptoms came on all of a sudden and have persisted for three months. I was diagnosed with Hashimoto's 28 years ago. Could Hashimoto's explain such a high ANA test result. Over the past five years my TSH has ranged from 29 to .03 with no known cause for the jumps. My TSH, T3, T4 etc. are now in the normal range. I have been treated for chronic depression for 8 years, but with these current symptoms, my Psychiatrist is convinced that something physical is going on. I do not have pain in my joints, or extrimities or thickening skin patches to suggest Scleroderma, though I occasionally have difficulty in swallowing, and find myself more easily winded than normal. Is Scleroderma the only autoimmune condition to give a positive Anti-scl-70 result? According to my lab results anything >1.0 is positive. Is a positive result just a positive result, or do degrees make a difference. I am trying to get an appointment with a Cleveland Clinic Rheumatologist, but nothing is available for 5 weeks. In the meantime, I have not been able to carry out my normally active schedule, and more than that, I am frightened and not sure how to procede. My internist was not particularly concerned by the ANA test, my endocrinologist was. Most autoimmune diseases/syndromes are quite rare. Is it possible that such a large ANA Titer means nothing? Any information you could provide would be greatly appreciated.
 
Answer  Your ANA test is clearly positive but none of the symptoms you mentioned are specific for lupus, scleroderma or other rheumatic disease. You must have specific symptoms or clinical findings to be diagnosed with any of these diseases. There are patients who have positive ANA testing but never develop any rheumatic illness. Hopefully your appointment with rheumatology in 5 weeks will be able to answer more of your questions.

Last update: 12:22 AM Thursday, April 26, 2007

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Alan Matsumoto, M.D.

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