Author Topic: Negative ANA, Positive SSB  (Read 619 times)

rowergirl

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Negative ANA, Positive SSB
« on: January 09, 2018, 05:37:11 AM »
Newly diagnosed with 'something.' Joint pains prompted blood work. ANA is normal. SSB is high at 4.5. Primary care doctor says it indicates Sjogrens and has referred me to Rheumatologist. I can't get into specialist for 4 months (!), but I found the following article that concludes that 96.7% of people with a positive SSB have Lupus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3702711/

Maybe I'm reading the study wrong, but if I'm only positive for SSB, is lupus more likely than Sjogrens?

Joe S.

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Re: Negative ANA, Positive SSB
« Reply #1 on: January 09, 2018, 02:43:28 PM »
The wait for the Fheumy is typical. It may take 7 years to get a diagnosis. I was DX'd on symptoms as blood work did not match. (Dry eyes, nose, mouth, skin, and a$$). There are often other symptoms that relate to malfunctioning glands.
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Linda196

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Re: Negative ANA, Positive SSB
« Reply #2 on: January 10, 2018, 04:02:15 AM »
I always dislike welcoming people, because it means they've had some sort of brush with Sjogren's, and I don't wish that on anyone, but Welcome!

In cases with only one positive antibody result, it's more commonly Sjogren's rather than Lupus, but I'm thinking your rheumy will look for more supportive blood work, indicating either a low titre SSA, which would indicate Sjogren's, or a dsDNA ( double strand DNA) which would indicate Lupus. They also look at the ANA pattern, even in a normal titre, and speckled leans toward Sjogren's while homogeneous or diffuse toward Lupus.

In the absence of a confirming "support" antibody, diagnosis relies on symptoms, and if yours lean more toward Sjogren's or Lupus, that will be your working diagnosis. That doesn't mean it's definitive, or that it can't be changed in the future, or that, if diagnosed with one, you won't develop the other at some point.

Autoimmunities are a jumbled, tangled lot, and differentiating between specific diseases can be trying.
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rowergirl

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Re: Negative ANA, Positive SSB
« Reply #3 on: January 10, 2018, 02:52:19 PM »
THank you for the helpful info, Linda and Joe. 

Tharrell

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Re: Negative ANA, Positive SSB
« Reply #4 on: January 12, 2018, 03:13:09 PM »
Hi rowerirl. I only tested positive ana once and was only ss-b for three years. After that a new rheumatologist ran a new panel that came up with high titres of anti-rnp so the diagnosis was mixed connective tissue disease with sjogren’s overlap. Mixed connective tissue disease over the years can lean towards a definitive diagnosis of scleroderma or lupus, but most will just stay mctd.
Did your doctor run the anti-rnp do you know?
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snoweye

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Re: Negative ANA, Positive SSB
« Reply #5 on: January 14, 2018, 10:45:26 AM »
I have always been confused by how it is possible to have a negative ANA but positive for SSB or SSA.

SSA ad SSB are part of the ENA category which is a sub category of ANA.

Theoretically it is actually impossible. The simple explanation is that the ANA test is not reliable and when you have a positive ENA then the test result for ANA is wrong..

For a detailed technical explanation here is a link:
https://www.researchgate.net/post/Is_it_possible_to_have_negative_ANA_and_positive_anti-DNA_in_SLE_patient

rowergirl, can you tell us please if any of your inflammatory markers are high? ESR or CRP?

SjoGirl

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Re: Negative ANA, Positive SSB
« Reply #6 on: January 15, 2018, 10:09:48 AM »
I was positive SSB and positive ANA when I was first diagnosed but then only positive SSB. I had the butterfly rash that is common in lupus (do you have that) and other symptoms, but was diagnosed with Sjorgrens where I live. I was then diagnosed with undifferentiated connective tissue disease when I went to Hopkins for a second opinion. My current rheumy says Sjogren's and sero-negative RA.

Ask for a full panel of reading ANA, SSA, SSB, B12, D, CBC, RF (test for RA), etc. If you can find a hematologist who will run all sorts of bloodwork to rule things out as much as rule things in.

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rowergirl

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Re: Negative ANA, Positive SSB
« Reply #7 on: January 15, 2018, 06:49:33 PM »
I have always been confused by how it is possible to have a negative ANA but positive for SSB or SSA.

SSA ad SSB are part of the ENA category which is a sub category of ANA.

Theoretically it is actually impossible. The simple explanation is that the ANA test is not reliable and when you have a positive ENA then the test result for ANA is wrong..

For a detailed technical explanation here is a link:
https://www.researchgate.net/post/Is_it_possible_to_have_negative_ANA_and_positive_anti-DNA_in_SLE_patient

rowergirl, can you tell us please if any of your inflammatory markers are high? ESR or CRP?

Hi.  Looks like Sed rate (which I assume is ESR) is normal.  ANA is normal.  Rheumatoid Factor is normal. I don't see any result labeled CRP.  The only abnormal result seems to be SSB.  Thanks for the link.  It really is so confusing, however.  Guess I won't know more until I see the Rheumatologist in a few months.

irish

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Re: Negative ANA, Positive SSB
« Reply #8 on: January 16, 2018, 11:33:22 PM »
I know very little info about this blood work, but IU do know that we can convert back and forth between positive and negative/ It may well be that the ANA can do that for a period off time and still run the positive SSB or SSA. The only thing for sure about autoimmune is that it changes all the time and we need to go with the flow. Irish

Kris29

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Re: Negative ANA, Positive SSB
« Reply #9 on: January 19, 2018, 04:37:32 PM »
Hi! Sorry you're not feeling well.

I can confirm irish's theory! My experience is that I tested positive for ANA just once, when I was diagnosed. (And I consider myself very lucky because my doc would have stopped looking without further tests if that had been negative!) Now my ANA is negative every time they run panels, but my SSA is always high, and my SSB has only been high once. So, my ANA has been "off" for years now, but I'm symptomatic and continue to test positive for other autoantibodies.

Interestingly, I just had a doc (a maternal fetal medicine specialist) say he wanted to treat my pregnancy as if I had lupus because my absence of SSB antibodies made him doubt a Sjogren's diagnosis and lean toward lupus or something else... I checked up on it and did find some support for Sjogren's being more common when SSB is present with SSA and SSA by itself being more aggressive/a different diagnosis.

Maybe this would mean that either SSB or SSA by themselves lean more toward lupus than the two together?