I am a physician and in my experience, the most successful patients are those who are proactive about their health and know as much about their particular medical situation as possible, and then they take appropriate steps to help themselves based upon that information. Remember, knowledge is power. One area for you to be fully knowledgeable of is being aware of the antibodies for which you are positive. Although almost all patients who have systemic lupus erythematosus (SLE) are positive for antinuclear antibodies (ANA), there are many other antibodies that you may be positive for that may be helpful for you to know about.
First, what are antibodies? Antibodies are proteins of the immune system whose role is to scour the body for foreign invaders by recognizing particular proteins on the invaders called antigens. An example might be an invasion of the streptococcal bacteria (the bacteria that can causes strep throat). Antibodies detect proteins on the strep bacteria (its antigens); designate it as foreign and then alert other cells of the immune system to destroy these bacteria. Bottom line: the strep throat can become a much less severe infection.
When one has lupus, the cells of the immune system mistakenly ‘think’ that our own cells are foreign and can produce antibodies that can attack them. The antibodies that do the attacking are called “autoantibodies,” where “auto-“ comes from the Greek word for “self.” So, what you have are antibodies of the body attacking itself.
Antibodies that can recognize and attack proteins of the nucleus of our cells are called “antinuclear antibodies.” Antinuclear antibodies are actually a very large group of different antibodies. Being ANA positive means that the person has at least one autoantibody being produced that targets a particular protein within the nucleus of the body’s cells. When the doctor notes a positive ANA, he or she usually tests for a bunch of different types of ANA’s as it can help figure out if that person may have lupus as the cause of the ANA. In addition, some types of ANAs can potentially give clues as to what particular potential problems to watch out for. The purpose of this blog article is to give some clues as to what things some ANAs may or may not mean.
The first step is to find out from your rheumatologist which antibodies you are positive for. Write them down, and then refer to this article. This article will list some antibodies, the symptoms and conditions they are associated with, and what you should do proactively with this knowledge. A VERY important thing to remember is that none of these antibodies are totally predictive of a situation. For example, although having a positive double stranded DNA antibody increases the potential of developing inflammation of the kidneys (nephritis), it does not mean that you will definitely not develop nephritis.
The best way for you to use this information (having a + double-stranded DNA) is to make sure that you give your doctor a urine sample at least 4 times a year to ensure that you do not develop nephritis, and if you do, it can be caught at an early enough stage to treat it at a milder stage before it becomes severe. Below is a list of some other antibodies and the symptoms, conditions and complications that they MAY cause:
Anti-phospholipid antibodies – These are now considered one of the criteria used to classify someone as having SLE. Approximately 50% of patients with anti-phospholipid antibodies will get blood clots over time (heart attacks, strokes, deep venous thrombosis, pulmonary embolism). Also associated with low platelet counts, hemolytic anemia, memory problems, miscarriages and a particular rash called livedo reticularis. Ask your doctor if you should take low dose aspirin daily to prevent blood clots. If pregnant, ask your doctor if you should take aspirin to prevent a miscarriage.
Taking Plaquenil® (hydroxychloroquine) daily also decreases the chances of getting blood clots and miscarriages from these antibodies. Get a complete blood cell count (CBC) done at least every 3 months. If you develop memory problems, discuss with your doctor. If you have Anti-phospholipid Antibodies, you may need to take Coumadin™ or its generic equivalent, warfarin and have your blood checked regularly. People with Anti-phospholipid antibodies may benefit by joining the
American Anti-phospholipid Association at http://www.americanaps.org
Beta-2 glycoprotein 1 antibody – See anti-phospholipid antibodies.
Cardiolipin antibody – See anti-phospholipid antibodies.
Chromatin antibody – 60% of people with this will develop kidney inflammation (lupus nephritis). Give a urine sample at least every 3 months.
Coombs’ antibody – This is now considered one of the criteria used to classify someone as having SLE by the new 2012 SLICC (Systemic Lupus International Collaborating Clinics) criteria. It can be associated with a particular type of anemia called autoimmune hemolytic anemia. Get a complete blood cell count (CBC) at least every 3 months.
CCP antibody – Increased risk for deforming arthritis like that seen in rheumatoid arthritis. Increased risk for having both lupus and rheumatoid arthritis (also called rhupus). See your rheumatologist ASAP if you develop morning stiffness that lasts for more than 30 minutes, or new onset joint swelling.
Double stranded DNA (dsDNA) – This is now considered one of the criteria used to classify someone as having SLE by the new 2012 SLICC (Systemic Lupus International Collaborating Clinics) criteria. Increased risk for kidney inflammation (lupus nephritis) and vasculitis (inflammation of the blood vessels). If you are + for this antibody, give a urine sample at least every 3 months. Let your rheumatologist know if you develop unusual tender bruised areas around your ankles (a common symptom of vasculitis).
False positive syphilis tests (false positive RPR or VDRL) – See anti-phospholipid antibodies.
Lupus anticoagulant – See anti-phospholipid antibodies.
Ribosomal P antibody – This antibody is 100% specific for SLE: only people with lupus are positive for it. Associated with liver, kidney, and skin lupus as well as with depression, anxiety disorder, and psychosis. If you are + for this antibody, get your liver blood enzymes and urine checked at least every 3 months, show any new skin changes to your doctor. Take moodiness symptoms seriously; discuss possible depression with your doctor and have it treated if present. Depression is a serious medical condition.
RNP antibody – Associated with Raynaud’s phenomenon, trouble swallowing due to esophageal dysmotility, pulmonary hypertension (high blood pressure in the lungs), and myocarditis (inflammation of the heart muscle). If you develop white or blue fingers with cold exposure, heart burn, trouble swallowing, shortness of breath, or chest pain… see your doctor for evaluation. You may have Raynaud’s phenomenon.
SS-A (Ro) antibody – These antibodies are associated with light sensitivity, Sjögren’s syndrome (dry eyes and dry mouth), lung inflammation, low platelet counts, myocarditis, pancreatitis, hepatitis, subacute cutaneous lupus, and having a baby with neonatal lupus. Use sunscreen religiously even if you don’t go outside. Let your doctor know if you develop dry eyes or dry mouth, shortness of breath, chest pain, or belly pain. Get your complete blood cell count and liver blood enzymes done every 3 months. If you get pregnant, let your obstetrician know as you will need to have your baby’s heart monitored regularly starting at the 16th week of pregnancy.
SS-B (La) antibody – Almost everyone with this antibody will develop Sjögren’s syndrome over time; report dry eyes and mouth to your doctor. You can have a baby with neonatal lupus … If you get pregnant, let your obstetrician know as you will need to have your baby’s heart monitored regularly starting at the 16th week of pregnancy. SSB positive patients actually have a lower chance of developing severe kidney inflammation (nephritis).
A word of advice; don’t let all of these potential associations scare you. They are potential. It is important to remember that most people with these antibodies do not get these problems. The one exception is Sjögren’s syndrome associated with SSB antibodies. The best way to look at them: educate yourself as to the possibilities and ensure you have the proper labs to make sure you don’t get these problems, and if you do… have them addressed and treated immediately so that you stay ahead of the problem.
These are but a few things that you can and should do when you have lupus
I thank Annie for inviting me to write this article on her excellent blog, and I wish all readers the best in life and health!
By Donald Thomas, MD
Author of “The Lupus Encyclopedia: A Comprehensive Guide for Patients and Families”