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What does high ANTI-DNA(DS) level indicate?

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Posted on Mon, 3 Mar 2014
Question: Hi, I am a 58 year white male. I had a triple CABG about 10 years ago and a knee replaced last year. My hands starting hurting last summer and have grownj worse3. My doctor did an ANA Direct which was POSITIVE. The ANTI-DNA(DS) AB QN result was 23. Ref. Range was 0-9. The report says this is high. My doctor has sent me to a rheumatologist. My question is how high is this result? I know more tests are needed but does this result mean I have SLE? Thanks
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Answered by Dr. Kakkar S. (1 hour later)
Brief Answer: Close folllow up needed to monitor titre. Detailed Answer: Hi. Thanks for posting your concern at XXXXXXX There are 11 clinical criteria for a lupus dx. You must have at least 4 of the 11 to recieve a dx. These 4 criteria can be positive simultaneously or serially during a given period of observation. They are: 1. malar rash over cheeks (butterfly rash) 2. discoid rash, red raised patches 3. photosensitivity - reaction to sunlight, resulting in skin rash 4. oral and nose ulcers 5. arthritis 6. serositis - inflamation (inflammation) of the lining of the lung or heart 7. renal disorder - excessive protein in urine and/or cellular casts 8. neurologic disorder - seizures, or psychosis 9. anemia or low white blood count or lymphopenia or low platelet count 10. positive ANA 11. positive anti-dsDNA or anti-Sm, or antiphospholipid antibody or false pos. syphilis test Anti-dsDNA are highly diagnostic of systemic lupus erythematosus (SLE) and are implicated in lupus nephritis. People who have positive ANA or Anti-ds DNA but cannot fulfill the clinical criteria for SLE need to be followed closely because they are at risk to develop SLE in future. Anti-dsDNA antibodies can be present in normal individuals, however these antibodies are usually low avidity IgM isotype. In contrast, pathogenic anti-dsDNA antibodies found in SLE are usually of IgG isotype and show high avidity for dsDNA. Titers of anti-dsDNA antibodies often fluctuate with disease activity, especially lupus nephritis, and are therefore useful in many patients for following the course of SLE. If a patient has a rising titer, or very high titer, but clinically is quiescent, it is considered a warning sign that the patient needs to be followed more closely. I would recommend a repeat test for both ANA with titresas well as anti-dsDNA with titres. Very high titres or rising titres do indicate need for a close watch. I would advice that you visit a dermatologist as well as a rheumatologist and discuss regarding your test results keeping all these points in mind. Your treating doctor might ask you to repeat the test in some time to monitor the titre. regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Kakkar S. (17 minutes later)
Thank you. I have an appointment scheduled for April. I was wondering about how high a result is the 23 for the Anti-DNA test and does how high or low it is factor into a dx of SLE. How worried should I be about the possibility of having Lupus.
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Answered by Dr. Kakkar S. (1 hour later)
Brief Answer: Repeat testing after 1-2 month for change in titre Detailed Answer: Hi. Your result of Anti-dsDNA, though above the normal range (0-9) is still NOT very high. I would advice repeat testing for both ANA and Anti-dsDNA after 1-2 months, to look for any change in titre. Rising titres OR very high titres of IgG Anti-dsDNA antibodies are closely associated with impending or already flared SLE. Anti-dsDNA is one of the criteria for the daignosis of SLE (only IgG Isotype is pathogenic), therefore it is specific for SLE. It is very difficult to predict the possibility of lupus just on the basis of a positive Anti-dsDNA without any other clinical features and investigations for other system involvement OR without fulfilling any other criteria required for the diagnosis of SLE but as i said, the titres should be watched serially for any change and also since the criteria fulfilling SLE might be present either simultaneously or serially over a period of time, so follow up with your dermatologist and rheumatologist is recommended. regards take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Kakkar S.

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What does high ANTI-DNA(DS) level indicate?

Brief Answer: Close folllow up needed to monitor titre. Detailed Answer: Hi. Thanks for posting your concern at XXXXXXX There are 11 clinical criteria for a lupus dx. You must have at least 4 of the 11 to recieve a dx. These 4 criteria can be positive simultaneously or serially during a given period of observation. They are: 1. malar rash over cheeks (butterfly rash) 2. discoid rash, red raised patches 3. photosensitivity - reaction to sunlight, resulting in skin rash 4. oral and nose ulcers 5. arthritis 6. serositis - inflamation (inflammation) of the lining of the lung or heart 7. renal disorder - excessive protein in urine and/or cellular casts 8. neurologic disorder - seizures, or psychosis 9. anemia or low white blood count or lymphopenia or low platelet count 10. positive ANA 11. positive anti-dsDNA or anti-Sm, or antiphospholipid antibody or false pos. syphilis test Anti-dsDNA are highly diagnostic of systemic lupus erythematosus (SLE) and are implicated in lupus nephritis. People who have positive ANA or Anti-ds DNA but cannot fulfill the clinical criteria for SLE need to be followed closely because they are at risk to develop SLE in future. Anti-dsDNA antibodies can be present in normal individuals, however these antibodies are usually low avidity IgM isotype. In contrast, pathogenic anti-dsDNA antibodies found in SLE are usually of IgG isotype and show high avidity for dsDNA. Titers of anti-dsDNA antibodies often fluctuate with disease activity, especially lupus nephritis, and are therefore useful in many patients for following the course of SLE. If a patient has a rising titer, or very high titer, but clinically is quiescent, it is considered a warning sign that the patient needs to be followed more closely. I would recommend a repeat test for both ANA with titresas well as anti-dsDNA with titres. Very high titres or rising titres do indicate need for a close watch. I would advice that you visit a dermatologist as well as a rheumatologist and discuss regarding your test results keeping all these points in mind. Your treating doctor might ask you to repeat the test in some time to monitor the titre. regards