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Discussion Starter · #1 ·
The only test so far I have had done was an antimitochondrial antibody test (AMA) which was extremely high. I know most on here haven't had this specific test done but when the doctor told me it was positive he said it was homogeneous and not speckled. He said "homogeneous would be more in the line of lupus, whereas scleroderma (?) would be speckled". Just curious if any knows if this is correct or what exactly homogeneous or speckled means.
 

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Hi LizaLou!

I've never heard of staining patterns (homogeneous, speckled, etc.) being linked to AMA results - only to ANA. I am very familiar with AMA testing, as my mother has had a long battle with an autoimmune liver disease. I suspect, since AMA and ANA sound so much alike, that there is a misunderstanding somewhere. I recommend you ask for a copy of the lab report that lists the results the doctor spoke to you about.

A second reason to suspect a miscommunication is that the AMA test is typically used when liver or biliary diseases are suspected. Although it can be elevated in SLE, the more common cause of a high positive result would be Primary Biliary Cirrhosis, a disease in which inflammation of the bile ducts leads to liver damage.

Terri
 

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Discussion Starter · #3 ·
Terri, Well the main reason my pcp ran the tests was I was having right upper quandrant pain (and I have a history of cirrhosis in my family...grandmothers with no known cause, they weren't drinkers). My doctor decided to run a bunch of basic blood work such as LFT's, hep C, and included AMA. My LFT's came back elevated and I had a ultrasound done of my liver which showed slightly enlarged liver and spleen. At that point the AMA results weren't back yet. Next thing I know I am getting a call from a rheumatologists office saying my pcp referred me to them. I called my pcp and he told me that the AMA came back extremely elevated (1:2560 highest he has ever seen since practicing). That is when he went on to tell me about it being homogeneous, not speckled. I have been trying to find stuff about homogeneous and speckled and it keeps linking me with ANA not AMA (just like you said). I almost wonder if the lab messed up and did an ANA not an AMA. I will go by the office to get a copy of the results. Ya know, come to think of it, when I spoke on the phone with my doctor I am not sure if he said your AMA came back 1:2560 or if your bloodwork came back 1:2560. Even if he realized lab had screwed up and done ANA, I am guessing at that point he would refer me to a rheumatologist. Hmmmm...this has me thinking now. Anyone else ever heard of AMA being described as homogeneous or speckled?
 

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Hello LizaLou :)

I think there is some mix up too. I had a good look through articles about liver disease and AMA and could see no reference to patterns in AMA. I did see a reference to AMA results being expressed as a titre 1:40 if I remember rightly, whereas ANA 1:2560 is high but not impossibly high. Many labs won't bother to test beyond 1:1280 because each dilution costs more and there is no point carrying on above a certain titre for practical purposes

The ANA patterns can indicate what specific antibodies might be present. Homogenous pattern could indicate the presence of histones or dsDNA
Speckled pattern might be associated with anti -Ro, anti Sm, anti RNP. It's more important to test for these specific antibodies than to go by the pattern. Ony two patterns are closely associated with specific diseases
Practically all blood test results have to be interpreted along with symptoms and signs and the results of other tests.
I have heard of abnormal AMAs and LFTs in people with Sjogren's which can be associated with liver disease. They often get upset because they initially get suspected of alcolohism

ANA might be present in cases of PBC but it is not diagnostic. Nor is AMA diagnostic of lupus whereas such a high ANA titre would strongly suggest autoimmune connective tissue disease probably lupus.

What your doc says abut speckled associated with scleroderma doesn't correspond with anything I have read. I think that's the nucleolar pattern and maybe one other I forget which. If he really said that, it suggests either he doesn't know what he's talking about, or he knows something none of the other lupus experts is aware of ! :) Time to get those results in black and white.

It isn't good form to give test results over the phone too many misunderstandings can arise and to get the results before you talk with the doc isn't a good idea until one is a very well informed, experienced patient.

Let us know when you find the exact details

Bye for now
Clare
 

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Discussion Starter · #5 ·
Clare, Thanks for all the information. I am really beginning to think the lab probably messed up and did an ANA. Doctor probably wasn't even thinking "hey this isn't what I ordered" when he saw the result. He probably just thought I need to refer her to a rheumatologist. I am going to get a copy of the results tomorrow and will update here. If the result was an ANA of 1:2560 what does that tell me? Does it say anything about disease severity being that high? Do you think my elevated LFT's are related to that high titer? Would sjogren's cause ANA to be elevated (I have been dealing with extremely dry mouth)?? Thanks again.
 

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Discussion Starter · #6 ·
I started a new thread but just wanted to update here that yes you guys were right...lab messed up and did an ANA not an AMA and I am actually happy this time that they screwed up.
 

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Quick answer: the titre of the ANA test has next to no relationship to disease severity. The higher the titre the more likely the ANA results is due to autoimmune connective tissue disease - but that's all you can read into the titre. The pattern can sometimes help point to certain diseases but it's just a higher liklihood & not absolute.

As I said in the other post... Sjorgen's patients very often have highly elevated ANA and I have read that overall they tend to have the highest titres along with lupus patients also tending to have very high titres.

I have less experience with abnormal LFTs... and how that may or may not be related to the ANA. There are more specific tests they can do to figure out the causes of those; and I'm sure the rheumy will run them given your family history.
 
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