What are anti Nuclear Antibodies (ANA)?

Our body needs to guard itself from germs, toxins, allergens, etc, which keep interacting with it all the day. For this, it has a specialized system, called the immune system.

One of the work this system does is making antibodies against all foreign invaders. Antibodies are certain proteins, which may be taken as bullets, used to hit the invader and hence protect the body.

Body cells first recognize a certain proteins molecule as foreign. After proper identification, bullets, that is, antibodies are made against it.

Sometimes, body cells may mistakenly recognize its own cells as foreign, and make a bullet against self. Such an antibody, intended for self destruction, is termed as Autoantibody.

Anti nuclear antibodies are antibodies directed towards one or more nuclear protein inside the cell. They are, thus, autoantibodies, intended for self destruction.

All individuals may have some of these antibodies. However, a higher amount of them in blood signals danger. It means that these antibodies are going to destroy some of the body’s functional cells, and thus cause clinical symptoms.

What does ANA positive mean?

Blood may be screened for ANA. If you are ANA positive, it means you are carrying considerable amounts of these autoantibodies, which may lead to destruction of your own tissues.

This is not desirable, and so treatment is required.

However, ANA tests are suggestive, not diagnostic. Your doctor needs to examine you and conduct further tests for diagnosis.

Also, false positive ANA results are not uncommon.

Common Conditions Showing ANA Positive

Conditions that show a self directed immune response are medically called auto immune diseases. These include a wide spectrum of clinically seen conditions.

Common among them are:

• Systemic Lupus Erythematosis
• Rhuematoid Arthritis
• Sjogren syndrome
• Scleroderma
• Thyroid Disease
• Temporal Arteritis
• Chronic liver Disease

So, if you are ANA positive, your doctor would examine you thoroughly to see any signs and symptoms your body expresses. He may order further tests to diagnose which condition, from the above list, is affecting you.

For example, if your joints are swollen, red and painful, and this is the chief complain you have come with, ANA positive may suggest the presence of Rheumatoid arthritis.

If you are having problems regarding your salivary glands or your tear glands, like getting less of secretions from them, ANA positive result may point towards Sjogrens syndrome.

Commonest condition diagnosed in ANA positive patients is SLE.

Systemic Lupus Erythematosis (SLE)

95% of patients having this condition are ANA positive. However, please note that there are cases of SLE which are not ANA positive. Also, all ANA positive patients do not have SLE. As mentioned above, there are several other autoimmune conditions that show ANA positivity.

Symptoms of SLE

Commonly, patients present with a clinical triad of fever, rash and joint pain.

Fever may be prolonged and low to moderate in severity. Rash is typically on the face, called the butter fly rash. It covers both the cheeks, and goes over the nose to connect the two parts.

Other parts of the body that may show the rash are hands, arms etc., usually the parts of the body that are exposed to the sun.

Joint pain is called arthralgia. The affected joint may not be red or swollen. It may just be painful.

Other body systems that may be affected include the heart, kidney, brain, lungs etc.

SLE is much common in women than men. It may express itself after teens. The condition shows self remissions and exacerbations. It usually lasts all life. However, it may be managed well with lifestyle and medicines.

The aim is to reduce the frequency and severity of exacerbations.

Drug Induced Lupus

Lupus like symptoms may be drug induced. Certain medicines may lead to this clinical condition.

However, this condition is totally reversible. The symptoms start fading as soon as the medicine is stopped.

Common medicines leading to lupus include- hydralazine, certain anti convulsants, isoniazid, procainamide etc.

Drug induced Lupus is associated with development of antibodies against histones (a protein inside the nucleus of the cells), anti histone anti body test may be ordered to confirm the diagnosis.

Management of SLE

SLE is not curable. However, the symptoms may be effectively controlled by lifestyle alterations and medicines.

This condition shows phases when the patient is absolutely alright, showing no signs of the illness, followed by phases of overt symptoms.

These are called phases of exacerbations and remissions. Effective treatment may reduce the frequency and severity of exacerbations, helping an individual to lead a normal life.

Medical Management

You need to see a specialist, rheumatologist, for this condition. After confirming the diagnosis, you may be put on any of the following drug regimen-

• Disease modifying antirheumatic drugs– These include Belimumab, Methotrexate, Azathioprine, cyclosporine, Rituximab, etc.
• Non steroidal anti inflammatory drugs (NSAIDS) may control symptoms. They include- Naproxen, Ibuprofen, Diclofenac etc.
• Corticosteroids, including methylprednisolone, prednisone.
• Antimalarials, like Hydroxychloroquine.

Lifestyle

• Leading a a stress free, healthy life style has been seen to benefit the condition.
• Include fresh fruits and vegetables in your daily diet. Having nuts would help. They contain essential oils that have been clinically seen to be helpful.
• During phases when you are free from the disease, exercise regularly. Maintain an ideal weight for your age and height.
• Stress management on a daily basis is a must. Most often, extreme stress becomes a trigger factor in causing exacerbations of the disease.
• Managing stress is personal. You may start with some meditation techniques. This works quite effectively for many.
• Consumption of alcohol and smoking have been seen to be detrimental. You need to keep a check on them.

Vitamin D Therapy

There is some evidence that people with SLE benefit from Vitamin D therapy. A short term vitamin D therapy may be given. Talk to your doctor about this.

DHEA Therapy

Dehydroepiandrosterone (DHEA) is a precursor of sex hormones in our body. Patients with SLE may sometimes show its deficiency in the body.

So, supplementing this hormone from outside may be helpful in some patients.