What can cause ANA titre of 1:2560?

Posted by carpe_bean @carpe_bean, Sep 18, 2017

Hi everyone,
I got really sick back in January and have been struggling to get a diagnosis or treatment. I've read quite a few chat threads on this site for some time but have never posted. I have a question no doctor has been able to answer. Maybe someone in this community might have some insight! In May a doctor tested my anti-nuclear antibodies (ANAs). The titre was 1:2560. I know ANAs can be elevated by autoimmune diseases, cancer, and viral/bacterial infections, among other things. So far, doctors haven't been able to figure out what's wrong, despite a host of weird symptoms and irregular tests. My question is: How likely is such a high ANA to be associated with an autoimmune disease? I've repeatedly read that the titres caused by viruses and bacterial infections are usually "mild", presumably <640. Is that true? Doctors have ruled out cancer, they don't believe it's a bacterial infection, but a virus is always a possibility. Can chronic viruses like Epstein-Barr cause such a high ANA? Has anyone else here personally experienced that? I've seen a handful of doctors, but most have been dismissive and unhelpful. I'm really frustrated. Hopefully someone here can provide some clarification. Thanks!

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Profile picture for pacer3702 @pacer3702

Hi Jennifer (not Janet),
Thank you for this additional information. I had read the article on Lumbar Plexus Compression Syndrome that you provided and it is fantastic! Thank you for sharing. A couple more questions: The article seems to discourage myofascial release for these health conditions (states that MFR has only temporary benefits), but you have found MFR to be of benefit. I would appreciate your insight. Also, horseback riding would be a fun way to recover, but I'm concerned about the bouncing action on my SI joints. If you just keep the horse at a walk, is the motion relatively minor? (It's a long time since I have been on a horse!) I have had one PT session that specifically addressed realigning the pelvis, which helped me a lot. Unfortunately, there is a 3 week wait until the next appointment. I'm wearing an SI joint belt daily, which also helps. Finally, I'm finding walking really helps.
Congratulations on the beautiful painting of your surgeon! You are so talented!

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@pacer3702 That's a good question about MFR. The physical therapist who wrote the article seems to be more of a traditional PT, so I don't think he completely understands MFR. If you try MFR once and stop, there wouldn't be much benefit. There are many layers of fascia to work through, so it may take weeks or months depending on how bad it is, but you need to keep it moving. I do a lot of stretching at home to maintain what I have gained.

Think of it this way. Remember when you were a kid and were much more flexible? Everything in your body moved and you were probably more active running around outside. Then we get older and sit too much and stop moving a lot. If you have an injury, the body tightens up. Even habits like always sleeping in the same position can lead to restrictions and we develop a pattern and can't move like we used to do. Stress adds tightness to our bodies, and surgery creates scar tissue not just on the skin, but in the fascial layers. When fascia stops moving, our bodies get stiff and we don't move as well. We can loose proper alignment of the spine, shoulders and pelvis. The small spaces where nerves and blood vessels pass between muscles can get pulled and compressed by tight fascia. That is what happens to me with compression points between the rib cage and collar bone for nerves that go to my arm because of thoracic outlet syndrome. Bones will go where they are pulled by muscles and tight fascia. In my case, I have tightness in the front of my neck and chest from thoracic outlet syndrome which really extends from my jaw down through my neck, rib cage and to my pelvis. Because that is too tight, it pulls the left Illium bone (hip bone) forward or inflared toward the center of my body. I have muscles in the low back that connect the spine to the pelvis that should be holding it on place, but those might be weaker from sitting too much, so the tight muscles on the front of my body win the fight and the hip bone moves forward and out of alignment and the joints are allowing the movement. Those muscles in the low back complain because they are being stretched and beat up. So the answer would be to release the fascial and muscle tightness in front, and strengthen the back to keep the pelvis aligned as it should be. Having a wider pelvis as a woman, makes it easier to twist out of shape because it is designed to be able to expand a bit for childbirth. That is a simple explanation and there are other muscles involved too, but they work in opposition to muscles that act on the other side of the bone where they attach.

Walking is great exercise for the back and pelvis and riding a horse at a walk does the same movement, but with a larger motion. In therapy this is used for patients who cannot walk to try to strengthen muscles they would need for walking and core strength. Waking a horse does not cause the rider to bounce, but you have to counter the motion with flexibility in the back. It is the same thing you do when you walk, but I think you get more effort and exercise onboard the horse if you are doing it right with good posture. You would have to try it to see if you think it helps. I think it may get things moving better because of bigger movements than walking on your own and you don't have the pressure of the footfall jamming your leg upward into the pelvis. I sometimes get an upslip like that where one leg becomes "shorter". My therapist will pull on my leg as I lay on the table. Think about what you do with really vigorous walking with big steps at a faster pace. That is similar to being on a horse, but you don't have to contend with numbness of your foot and worrying about if it will give out when you step on it.

I used to have physical therapy 2 or 3 times a week at the beginning and I do it once a week now. I have been doing PT for several years because of the TOS which is a hard problem to correct, and horse back riding does a lot to help because I have much better posture and core strength.. I think that waiting 3 weeks for a next PT appointment is too long because the pelvis can revert back to old habits too quickly. You might ask your PT if more frequent sessions would be more beneficial if your insurance covers it. If walking really helps I would keep doing it, but also remember to stretch and ask your PT the best ways to do that.

Here is something else you could ask your PT about. This can align the sacrum is if goes out just by laying on it. My pelvis can push the sacrum out too and this has helped me. https://www.sacrowedgy.com/store/

Thank you for your comments about the portrait of my surgeon. I really enjoyed painting that for him, and it was a big test for me as I was recovering because I needed to prove to myself that I could regain the coordination I had lost because of the spine problem. His surgery gave me back that ability and I could not think of a better way to express my gratitude.

Did you have any more thoughts about horse therapy? It may add a benefit to what your physical therapist is doing for you.

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Profile picture for daisydo @daisydo

PS. I have had to take steroid eye drops to combat the uveitis attacks, but that's not quite the same as taking it orally, even though a small amount ends up in the blood.

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Both my oncologist and dermatologist wanted to prescribe me a steroidal cream for the side effect rash from Revlimid that appeared on my lower legs. Nope!! Not going there. Cleared it up with Vitamin E cream alternating with CBD cream. I also take a baby aspirin per day, plus once a week 20 mg of dexamthasone as part of my chemo regimen.
Ginger

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Profile picture for daisydo @daisydo

Thanks Ginger. I have already shown them both the research that showed that the difference in whether MGUS converts to multiple myeloma - or doesn't, depends on whether the body can mount an immune response to the SOX-2 on the MGUS/myeloma stem cells. So unless and until the good portion of my immune system shows that it's truly failing already, to fight the MGUC cells and keep them at a steady state, I won't be taking any immune suppressants stronger than baby aspirin.

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PS. I have had to take steroid eye drops to combat the uveitis attacks, but that's not quite the same as taking it orally, even though a small amount ends up in the blood.

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Profile picture for Ginger, Volunteer Mentor @gingerw

@daisydo Get your hematologist and rheumatologist to communicate with each other, and work together to handle your case! It is crucial to your health! From what you have related here, you are not one to stand on the sideline, so having them understand you are looking at all the interactions may have them step up their interest.

I have had to do that with my oncologist and nephrologist.
Ginger

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Thanks Ginger. I have already shown them both the research that showed that the difference in whether MGUS converts to multiple myeloma - or doesn't, depends on whether the body can mount an immune response to the SOX-2 on the MGUS/myeloma stem cells. So unless and until the good portion of my immune system shows that it's truly failing already, to fight the MGUC cells and keep them at a steady state, I won't be taking any immune suppressants stronger than baby aspirin.

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Profile picture for Jennifer, Volunteer Mentor @jenniferhunter

@pacer3702 Hi, Jennifer here. Have you tried working with a physical therapist? I do and it is common for my PT to adjust my pelvis because it goes out of alignment.. It is not as bad as it used to be, and I also do a lot of myofascial release which helps get things moving and realigned properly. It's great that you have an appointment at Mayo, but don't worry, the PA should be good and they can always consult with a physician if needed. My spine surgeon's nurse is now a PA there and she was just wonderful. Surgery isn't always the best answer. Usually, more conservative methods are tried first like physical therapy. At one time I was wearing an SI belt to keep that stabilized. I find that horseback riding helps me a lot by strengthening my legs, pelvis, hips and back and by building core strength. It is just trail riding at a walk, and I have learned some ways to adjust my pelvis myself it is goes out. I need to stretch the hip flexors in front to help too. Did you see the links in the post that you responded to about Lumbar Plexus Syndrome? https://mskneurology.com/identify-treat-lumbar-plexus-compression-syndrome-lpcs/

Here is our MFR discussion.
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

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Hi Jennifer (not Janet),
Thank you for this additional information. I had read the article on Lumbar Plexus Compression Syndrome that you provided and it is fantastic! Thank you for sharing. A couple more questions: The article seems to discourage myofascial release for these health conditions (states that MFR has only temporary benefits), but you have found MFR to be of benefit. I would appreciate your insight. Also, horseback riding would be a fun way to recover, but I'm concerned about the bouncing action on my SI joints. If you just keep the horse at a walk, is the motion relatively minor? (It's a long time since I have been on a horse!) I have had one PT session that specifically addressed realigning the pelvis, which helped me a lot. Unfortunately, there is a 3 week wait until the next appointment. I'm wearing an SI joint belt daily, which also helps. Finally, I'm finding walking really helps.
Congratulations on the beautiful painting of your surgeon! You are so talented!

REPLY
Profile picture for daisydo @daisydo

The problem with scleroderma is that the real immunosuppressants that are used for it have their own bad side effects, so the docs reserve it for non- sine cases. In my own case, I also have MGUS, and immunosuppressants could actually tip me over into conversion to multiple myeloma. That would put me from the frying pan into the fire.

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@daisydo Get your hematologist and rheumatologist to communicate with each other, and work together to handle your case! It is crucial to your health! From what you have related here, you are not one to stand on the sideline, so having them understand you are looking at all the interactions may have them step up their interest.

I have had to do that with my oncologist and nephrologist.
Ginger

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Profile picture for Ingegerd Enscoe, Alumni Mentor @astaingegerdm

@daisydo - You know your body well and you don’t give up researching and pushing.
I have other autoimmune illnesses and I’m surprised that many physicians in immunology/ rheumatology are not keeping up with new research.
It is surprising that if you look healthy, you can’t have a serious illness.
My daughter lives overseas and knows she has more than one autoimmune illness- celiac disease, but it’s a struggle to get the healthcare system interested enough to put a diagnosis on other symptoms that affect her daily life.
She knows she has to keep pushing!
I wish you well!

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The problem with scleroderma is that the real immunosuppressants that are used for it have their own bad side effects, so the docs reserve it for non- sine cases. In my own case, I also have MGUS, and immunosuppressants could actually tip me over into conversion to multiple myeloma. That would put me from the frying pan into the fire.

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Yes, I have never heard of "Twilight Lupus" and I'm quite certain he made that one up. Though lupus can have its exacerbations and remissions, I have never heard of it going away.

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Profile picture for Ginger, Volunteer Mentor @gingerw

@daisydo It's tough enough dealing with an autoimmune disorder. But to hear "but you look fine" "you don't look sick!" can be discouraging and frustrating, especially when it comes from a trained medical professional. I have heard that from doctors and nurses! I was diagnosed in 1988 with Systemic Lupus and have fought long and hard to advocate for myself. For 20+ years they attributed my super high protein levels to be related to the lupus, until an interested dr and then a nephrologist decided to look into it further in late 2014 and found I had a rare kidney disease! Like you said, the damage was done by then.
Ginger

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@gingerw, @daisydo. I had several high ANA readings and several bouts of pleurisy and pericarditis in 1977 and was ultimately diagnosed with lupus by an internal medicine specialist. There were five years or so of fairly serious lupus symptoms. I was working full-time as a Legal Secretary and single parent to three young sons. Hard times! Eventually I began to feel better and the specialist then termed my illness as "twilight lupus". When I tell my current doctors that, they smile quizzically and say they've never heard of it! I now have about four autoimmune diseases but no doctor has ever checked my ANA reading to see if lupus is still lingering in the background, even though I've (politely) requested the test. I guess it doesn't really matter anymore what I have. All my docs say I'm a very complex patient! Sending my best to you. Laurie

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Profile picture for daisydo @daisydo

I became sick in about 1997 and was discovered to be running an ANA titre of 1:2560. After doing extensive searches of the pubmed.gov database, I came to the conclusion that there are really only two things that ever drive the ANA up that high: lupus and scleroderma. My first doc said I was a lupus suspect, but finally the ANA pattern showed up as anticentromere, which is supposed to be specific to limited systemic sclerosis (limited systemic scleroderma, formerly known as CREST syndrome). That doc left for another state without following up on that clue, because basically, although I had developed puffy fingers, I didn't "look" like I had scleroderma.

The second doc was convinced that I had lupus, even though I knew I did not fit the criteria. What's more, lupus is supposed to depress complement, while scleroderma elevates it. My complement was elevated.

To make a long story short, the docs were still using an archaic set of criteria (from 1980), that did not recognize sine scleroderma. When a worldwide consortium of scleroderma docs finally revised the criteria in 2012, I was finally able to be diagnosed with limited systemic sclerosis (sine type). In this new set of criteria, my puffy fingers played a big part in the diagnosis. But by then I also had Raynaud's, and the typical nailfold capillary changes that could be seen with capillaroscopy. These things together with my anticentromere antibodies gave me 12 points toward diagnosis. Only 9 points are needed for a definitive diagnosis. So, even though I don't "look" like I have scleroderma, I do have it. It has stiffened my heart muscle, giving me left ventricular diastolic dysfunction and secondary to that, pulmonary venous hypertension. I must now sleep on a wedge to prevent gastric reflux. It affects the GI tract, so I alternate between constipation and diarrhea, with lots of flatulence. It has attacked my thyroid, causing hypothyroidism, weight gain, and with that, obstructive sleep apnea. It has attacked my tear glands, causing severe dry eyes. It has attacked my eyes, too, causing multiple episodes of bilateral acute anterior uveitis. I have antiphospholipid antibodies and episodes of livedo reticularis if I get chilly. I am now very careful to stay warm to avoid blood sludging and clots. I have had soft tissue arthritis in my hands, and elbows. Basically tendonitis all over. I have had frozen shoulder, first in the right shoulder and much later in the left shoulder. More recently it has affected my kidneys, putting me into stage 3 CKD. Since the very beginning I have had prickling pain in my arms and lower legs. This neuropathic pain is pretty constant.

So, what I am saying is that even if you don't LOOK like you have scleroderma, you may still have it, and since it's such a rare disease, there are probably still many rheumatologists out there who are unaware of the newer criteria. The newer criteria may be seen by Googling " 2012 scleroderma criteria" and switching to images, where you can see point charts showing how many points each criteria is given. If you don't really fit the criteria for lupus, I'd recommend getting yourself to a major scleroderma center, like at Johns Hopkins (Dr. Laura Hummers) or at Georgetown University Medical center (Dr. Virginia Steen).

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@daisydo - You know your body well and you don’t give up researching and pushing.
I have other autoimmune illnesses and I’m surprised that many physicians in immunology/ rheumatology are not keeping up with new research.
It is surprising that if you look healthy, you can’t have a serious illness.
My daughter lives overseas and knows she has more than one autoimmune illness- celiac disease, but it’s a struggle to get the healthcare system interested enough to put a diagnosis on other symptoms that affect her daily life.
She knows she has to keep pushing!
I wish you well!

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