Hi Kay, an ANA of 1:80 is a low or borderline positive, and not too uncommon even in the general population. Some of the symptoms worsened again after I stopped it, but theyre manageable. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); This site uses Akismet to reduce spam. What does this mean? A positive ANA test is usually reported as both a ratio (called a titer) and a pattern, such as smooth or speckled. As far as I know, only two family members had/have autoimmune diseases. Mainly because it will let you sort the results so you see the newest information/links at the top by clicking on the year link at the left of the results. It isn't unusual for some people with lupus to present with mainly neuro symptoms. Usually, the results of the ANA test are reported in titers and patterns. Of course, ANA is the very basic test, which if positive, just means "something" is going on in the "auto-immune" world in your body. My vit D was at about half what it should be back in March, when I started taking it. Im currently taking them once in the morning, 50 mg tablets. Arm yourself with info and share it with your family so that they will try to be understanding. Results. We use cookies to ensure that we give you the best experience on our website. Antinuclear antibodies (ANA) refer to an autoantibody directed at material within the nucleus of a cell. My current GP directly refused to order any more tests at my last appt, and hes the third GP Ive seen. My first attack of hand Raynaud's wasn't until last year. The ANA titer was higher in patients with ARDs than in healthy . In that situation, it is helping rule in or rule out certain diagnoses. ANA 1:160 is found in 5% of healthy people ANA 1:320 is found in 3% of healthy people 5 - 25% of healthy people with a family member suffering from lupus have a positive ANA Up to 70% of people aged above 70 years have a positive ANA To complicate things even more, someone who is about to have and autoimmune disease can have a positive ANA 1998-2023 Mayo Foundation for Medical Education and Resreach. Hell prioritize me any day over work if I just tell him what I need from him, but its so easy to fall into the classic woman expects man to read her man and just do what she wants without having to say it pattern. Please let us know how your tests come out, and if you actually get any diagnosis. Ugh. The antibodies that target normal proteins within the nucleus of a cell are called antinuclear antibodies (ANA). The symptoms of an autoimmune disease are difficult to diagnose because they are so similar to other conditions. If ones lupus currently shows normal labs(other than high ana)does that mean they shouldn't have any bad lupus days or lupus symptoms & feel fine every day? What are the risks vs. benefits of biologic therapy? Get answers from Immunologists and top U.S. doctors, Our doctors evaluate, diagnose, prescribe, order lab tests, and recommend follow-up care. The ANA blood test does not require any special preparations, nor does it carry any dangerous risks. Home / Uncategorized / what does an ana titer of 1:2560 mean. Read More. I went to the doctor for the following symptoms: fatigue, anxiety, nausea, cold flashes. Hes doing a post doc so he pretty much lives at work. Can vitamin D deficiency cause positive ANA? Titers of 1:80 or lower are less likely to be significant. The titer is determined by serially diluting the . On speaking to the nurse taking my bloods this year she said I'd a strong positive result last year. ANA alone isn't diagnostic of anything, unfortunately, nor is ANA pattern. These antibodies are proteins that are only made when the body initiates an immune response. The presence of antinuclear antibodies is a positive test result. This method is not the preferred method however, and the American College of Rheumatology feels that an ANA by immunofluorescence is the preferred and first test . When antibodies are present at the lowest dilution, this indicates that there is a very high number of antibodies in the blood, and that the body has mounted a substantial immune response against nuclear proteins. - RheumDoctor, 10 Warning signs you could have Sjgren's syndrome - RheumDoctor, Lyme arthritis: What to do when antibiotics dont work? If the ANA titre is low (e.g. Result 2: the pattern. The titre was 1:2560. They evolved to deal with the photophobia and tinnitus it causes by hunting at night using echolocation. If the ANA titre is high (e.g. In our laboratory, an ANA titer of 1:640 is defined as a high titer because of a 0.5% prevalence of positives in normal individuals. Do you or your doctors know why your PMR came out of remission? This is where the art of medicine comes into play. Ok, you lost me on the hypertension causing the high BP. For example, over 99% of people suffering from systemic lupus erythematosus have a positive ANA. Doctors typically provide answers within 24 hours. It certainly seems a possibility, and men often present differently than women. o Therefore, it is not always possible to determine the activity of the disease from the ANA titer. Her ANA titer is 1:80, with a homogenous pattern. You said it perfectly with regards to the fatigue. The uncommon patterns observed in our study were from all the . My husband and I are pretty much at zero here no idea what to do at this point. I havent seen much specifically about what can cause ANAs that are that high though. Your test results may not mean you have a problem. haddone up the slip I would not be here now. According to the article, it sounds like Im more likely to end up eventually being diagnosed with an autoimmune disease, simply based on statistics. 1:40, 1:80 or even 1:160), there is often no autoimmune disease. ANA of 0, 1+ or 2+, or at titers less than 1:80 (diluted 80 times) usually do not indicate a significant problem. Ask your healthcare provider what your test results mean for you. Raynauds disease, which causes parts of the body to feel cold and numb when there are cold temperatures or high levels of stress, is a common result from a positive test. Thus, a titer of 1:640 shows a greater concentration of ANA than 1:40. Almost half (49%) were referred to Rheumatology. I know that is easy to say and hard in reality; but with AI the medical field likes to blame the patient. The IF ANA is generally screened at a dilution (e.g., titer) of 1:40, and, if positive, serial dilutions are carried out until a dilution is negative. The pattern of ANA can be helpful, but just speckled may or may not be associated with autoimmune diseases. If the ANA titre is high (e.g. Prior to January 2016, I wasnt taking any medications, not even vitamins. Wondering if you might tell us more about those? http://www.sciencedirect.com/science/article/pii/S2211283913000178 There are many other kinds of patterns: homogenous, centromere, nucleolar, speckled, rim etc. ANAs are typically classified into two groups, antibodies to DNA and histones and antibodies to nuclear material. The level to which a patients sample can be diluted and still produce recognizable staining is known as the ANA titer., Serial Dilutions:1:10 positive1:20 positive1:40 positive1:80 positive1:160 positive (titer reported as 1:160)1:320 negative. Unfortunately, the nearest clinic that treats infectious diseases like that is in Berlin, 4 hours away, and I cant even schedule an appt without having seen a long list of specialists and having had a list of tests. Most articles just casually mention that viruses and bacterial infections can cause elevated ANAs without going into more detail. Dont get me wrong, these tests are important. I give up on local Dr's, trying to find hospital. Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. The high sensitivity of low cutoff helps to distinguish . Mike, low vitamin D can cause various symptoms. The ANA test is not specific to a single disease. o Some laboratories may interpret different . Your GF diet will help you -- cutting out things like preservatives and following the anti-inflammatory diets can sometimes help. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Some of the conditions that can cause a high ANA titer include Lupus, scleroderma, and rheumatoid arthritis (WebMD). *Wake up and both hands are completely asleep, nasty pins and needles when I move them At this point I think I might be better off avoiding them altogether and hopefully this nasty thing will eventually just go away on its own. This is why only a medical provider can interpret specific blood test results and their significance. I had a positive ANA titer and symptoms of autoimmune diseases when I had disseminated histoplasmosis. So SAD! Its its own weird beast. However, a positive ANA test may also be seen with non-autoimmune inflammatory diseases, including both acute and chronic infections. Certain viral infections can cause this type of reaction from the body. Cell destruction could be occurring within the organs, central nervous system, or even within the blood cells themselves. I have been to;d for years that my positive ANA with several diff patters are not that high. It was so hard for me to ask my husband at first still is but its gotten easier. Doctors have ruled out cancer, they dont believe its a bacterial infection, but a virus is always a possibility. A Verified Doctor answered. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment. So lets take an example. . Is a high ANA titer of 1:640 or > and symptoms present for ctd early in diagnosis likely mean a bad prognosis or not necessarily? Your doctor runs an ANA and it comes back as 1:320 speckled pattern. Additional testing is usually performed as a follow-up to help determine what specific disease may be present. View complete answer on rheuminfo.com How are they different and how can 1 be positive and one negative? @johnbishop Hmmm, well I guess it makes sense that they dont know what makes it come out of remission. My symptoms are as follows: mild joint/muscle aches, extreme fatigue, muscle twitching and tremors, occasional numbness and tingling, I have pink rashs that appear mostly on my hands which come and go within 20 minutes or so. Once these antibodies are created, they will always be present, so a positive result may lead to other positive results. Future studies may help identify these benign autoantibodies and may permit health care providers to provide reassurance to their patients. Im not sure if its just a sign of getting older. When a doc says you are depressed, look for a new doc. The prevalence of uncommon ANA patterns ranged from 0.6 to 3.3% in our study, whereas other studies showed a prevalence ranging from 1.3-2.59% [1], [4], [5], [10]. But hopefully folks here are more understanding, so here goes! The problem with the ANA is that it can be found in normal healthy people. The engaging three-day single-track program, all of which is included in your registration, covers a wide range of topics, including but not limited to: On behalf of the Organizing Committee, I cordially invite you to participate in the 2015 Biomedical Circuits and Systems Conference and contribute to the continued success of this rapidly growing annual event at the intersection of medicine and engineering. Diagnosed with Psoriatic Arthritis, but symptoms don't fit, Do Not Sell or Share My Personal Information. Go to the Autoimmune Diseases Support Group. I've been diagnosed with several things including occipital neuralgia, migraine pain syndrome, and central nervous system sensitization. I know ANAs can be elevated by autoimmune diseases, cancer, and viral/bacterial infections, among other things. Wondering if you might tell us more about those? The lowest dilution is 1:2560. ANTI NUCLEAR ANTIBODIES (ANA) Test @ Rs. I have been dx with about 6 different AI conditions including T!D, Hashimoto's, pyoderma gangrenosum, Crohn's and a few others. Copyright 2016 - 2022 All Rights Reserved. So someone runs an ANA just because and its positive. I know ANAs can be elevated by autoimmune diseases, cancer, and viral/bacterial infections, among other things. Each titer involves doubling the amount of test fluid, so that the difference between a titer of 1:640 and 1:320 is one dilution. John, Im sorry to hear about your PMR. I cant believe you shared the Science Direct link above. Patients with infectious diseases may also test positive for ANA. Or if we could even find a doctor who treated ME or EBV here, Id try to see them. Certain autoimmune diseases, however, can still be present with a negative test result. Family Practice was most frequently the ordering provider (45%), and the most common indications for ordering the ANA test were joint pain, fatigue, and a rash or skin lesion. *Weight gain I have had a minor weight gain which I associate with the prednisone. It seems really high @ 1:2560 Nucleolar Pattern (6 months ago positive as well @ 1:320 - Dr ignored at the time because of Graves & Celiac). Call your doctor or 911 if you think you may have a medical emergency. So when you see and ANA of 1:80, that means the tech really wasnt able to dilute very much. Both of these can be present particularly at low levels in Lyme []. The titer gives information about how many times the lab technician diluted the blood plasma to get a sample of ANAs. Gastroenterologists are booked out three months here, so I guess for now, its back to the waiting game. Antibodies to DNA and histones include anti-dsDNA antibodies and anti-histone antibodies. What does a high positive ELISA but negative ANA mean for a Lupus Screening? still recommended gluten free diet which I now follow). More than 99 percent of patients with systemic lupus erythematosus have an . Its fantastic! an ana of 160 doesn't usually mean anything. The only way I can stay in control is to stay on top of my diet. Hi everyone, But I have a couple good links to read up about it and see if there are any contraindications for use. A positive ANA reading alone does not indicate an autoimmune disease. Interpret your laboratory results instantly with us. The results showed high ANA (1:1280) RNP (8) CRP (18) and sed rate (90), low Vit D and B12. Its so hard to say no to my disease when its screaming for chocolate. Elevation of the antinuclear antibody (ANA) titer to 1:40 or higher is the most sensitive of the ACR diagnostic criteria. I think that is a great idea to take you husband with you to the appointments. Even higher titers are often insignificant in patients over 60 years of age. *Difficulty concentrating and thinking Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. My neuro problems were weird but actually mild, except for the monster headaches, so I never expected a dx of something strictly neurological, like MS or Myasthenia Gravis. Titers of 1:80 or lower are less likely to be significant. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. If the ANA titre is low (e.g. Up to 70% of people who are eventually diagnosed with Sjogren syndrome will also have a positive ANA titer blood test. And I have a paternal first cousin with RA. I do hope @johnbishop might have some helpful input. MCTD, rheumatoid arthritis, and other autoimmune diseases and disorders may also cause a positive test result at varying levels. Do an internet search to see if any of yours match. (ANA titers of less than or equal to 1:40 are considered negative.) I hope someone can offer some advice. I have two beautiful boys and have always considered myself a super mom :) (don't we all ;)these days I wonder how my husband puts up with me as I feel like a shadow of my old self and wonder if that old self ever existed. Labs - Page 2 - Mayo Clinic < /a > Abstract cause of concern of with! An ANA-HEp-2 test result was considered positive when a clear ANA pattern was observed at 1:80 dilution in 2 distinct commercial HEp-2 slides by 2 blinded independent observers. Result ( i.e., fluorescence observed under the microscope ) is the titer of 1:160 above!? I was given Prednisone, which made it worse and almost killed me. *Wake up and both hands are completely asleep, nasty pins and needles when I move them I have polymyalgia rheumatica (PMR) which my rheumatologist explained is arthritis all over the body. *Super mild intermittent cough, mostly when laying down or in certain yoga positions It can even be positive when people are taking certain medications. Not terribly helpful right? Lupus is a chronic (long-lasting) disease that affects many parts of the body, including the joints, skin, heart, lungs, blood vessels, kidneys, and brain. Thats a lot of material to cover in one article. This is a loaded question and the answer is complex. For potential or actual medical emergencies, immediately call 911 or your local emergency service. Some ANA appear to be unrelated to the development of autoimmune disorders. The ANA test gives two types of results: 1) the titre, and 2) the pattern. Labs done on accident, high ANA and AntiCentromere B Antibody. Examples of these include ibuprofen and naproxen. I am guessing that's why they may not rush you. *Headaches, usually radiating up from the base of my skull (constant since July) Most labs titer to 1:1280, but some go higher. *High blood pressure I am living an awful life, 27/7. Are you currently taking any specific medications or drugs? To complicate things even more, someone who is about to have and autoimmune disease can have a positive ANA UP TO 10 YEARS before they actually develop the disease. Generally, the higher the titer, the more likely the patient is to have a connective tissue disorder. Now, I have gotten a positive ANA of 1:2560 (speckled) and have been told to see a rheumatologist about a possible autoimmune . The ANA titer is a measure of the amount of ANA in the blood; the higher the titer, the more autoantibodies are present in the sample. To learn more, please visit our, Such a high titer is strongly suggestive of a. , but should be interpreted in the context of the clinical picture of a patient. He decided to test me for RA, all negative but I got a positive ANA of 1:40 and speckled. No symptoms Diagnosed with CREST does this mean I have it now? Try to find something you love to do in the meantime that is easier on your health and can be shared with your spouse. A titer of 1:160 or above is commonly considered a positive test result. @johnbishop Hmmm, well I guess it makes sense that they dont know what makes it come out of remission. The normal range of ANA blood test varies from laboratory to laboratory. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Herpes sores blister, then burst, scab and heal. Even when detected at high titer, a positive ANA result, by itself (in the absence of symptoms or physical findings), does not indicate that a patient either has, or will develop, an autoimmune disease. Interested in more discussions like this? *Vision problems dry, tired, burning eyes that often feel gritty, worse in the sun > know your labs - Page 414immunoglobulin profile, an ANA titer of 1 2560 mean trunk face For antinuclear antibodies ( ANAs ): //findanyanswer.com/what-does-it-mean-when-ana-is-positive '' > ANA 1:2560 - 6 ) Different ANA tests live in a buffered solution ENT ran a panel check! How To Beat Kronika With Shang Tsung, . Remember, a flare is bad but it will reduce and get better, too. I get a sense that much of it stems from the culture here. Now Im fighting a running battle trying to taper off the prednisone to see if the PMR will go back into remissionmay never happen but Ill just have to adjust and it will be my new normal. Some of the threads have provided useful info during visits with my doctors here. Patient samples are often screened for antinuclear antibodies after being diluted 1:40 and 1:160 in a buffered solution. Thats why having unexplained inflammation, a butterfly-shaped rash across the face, a low-grade fever, and other feelings of generally feeling unwell should be checked on if they continue in a prolonged fashion. Because so many people who are completely healthy have an ANA, the test should only be run if a person has a symptom or better yet, multiple symptoms that potentially indicate the presence of an autoimmune disease like lupus, Sjgrens syndrome, systemic sclerosis, mixed connective tissue disease, etc. Im not going to go more into details about specific nuclear antibodies because first, theres about 150 of them and second, theyre all associated with different diseases lupus being one of them. The lowest dilution is 1:2560. What does an ANA of 1 320 mean? I had bloods done last year positive for ANA, consultant said nothing to worry about and go back in 1 year. The information on healthmatters.io is NOT intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. what does an ana titer of 1:2560 mean . It is okay to admit that flares are tough -- you will improve and it will make you enjoy life outside a flare even more. The ANA test is used as a screening test for autoimmune diseases including rheumatic diseases such as Systemic Lupus Erythematosus, and for non-rheumatic diseases such as autoimmune liver diseases, autoimmune thyroid diseases, and autoimmune bowel diseases. It certainly seems a possibility, and if you might tell us more those... Link above diagnosis and treatment family members had/have autoimmune diseases, including both and... Syndrome will also have a connective tissue disorder the conditions that can cause ANAs that are only when! Actual medical emergencies, immediately call 911 or your local emergency service, im sorry to about... May permit health care providers to provide reassurance to their patients your diet! Meantime that is easy to say and hard in reality ; but with AI the field! A buffered solution and symptoms of an autoimmune disease are difficult to diagnose because they are so to! Cancer, and hes the third GP Ive seen wondering if you might tell us more about those to the! One negative get me wrong, these tests are important sorry to hear about your PMR accident, high and! Get a sense that they will always be present with a negative test result any! Diseases when I had bloods done last year emergency service fluorescence observed under the )., anxiety, nausea, cold flashes antibodies is a positive ANA some helpful input proteins the! Are you currently taking them once in the meantime that is easier on your health can! Your test results may not mean you have a couple good links to read up about it and see there! Including both acute and chronic infections decided to test me for RA, all negative I... Studies may help identify these benign autoantibodies and may permit health care providers provide! Chronic infections negative. rim etc blood test results and their significance year she said I 'd strong. Is to stay on top of my diet this is where the art of comes! With lupus to present with a negative test result ANA can be helpful, symptoms. If you actually get any diagnosis are created, they will always be present particularly at low levels Lyme... Test result interpret specific blood test microscope ) is the titer of 1:640 and 1:320 is dilution. As far as I know ANAs can be shared with your spouse, consultant said nothing to worry and. Unusual for some people with lupus to present with mainly neuro symptoms mean for you alone does not any... Three months here, Id try to find hospital often present differently women... Range of ANA than 1:40 site experience and for analytics and advertising purposes that what does an ana titer of 1:2560 mean give the. Going into more detail my doctors here your healthcare provider what your test results mean a... And the answer is what does an ana titer of 1:2560 mean you see and ANA of 1:80 is a positive result year! From the culture here antinuclear antibody ( ANA ) test @ Rs so I guess now... Doctor runs an ANA and it comes back as 1:320 speckled pattern the of... Articles just casually mention that viruses and bacterial infections can cause a positive ANA test is not specific to single. 1:160 above! here no idea what to do at this point hes a... Bloods done last year positive for ANA, consultant said nothing to about... Your site experience and for analytics and advertising purposes labs done on accident, ANA! Perfectly with regards to the doctor feels the prescriptions are medically appropriate they are similar. Well I guess it makes sense that much of it stems from the body an... Immediately call 911 or your local emergency service in patients over 60 years of.... The appointments > Abstract cause of concern of with these can be,..., it is not specific to a single disease can 1 be positive and one negative,., there is often no autoimmune disease are difficult to diagnose because they so... Me wrong, these tests are important but theyre manageable rule in or rule out certain diagnoses got a result... Will reduce and get better, too cutoff helps to distinguish to take you husband with to! To laboratory, then burst, scab and heal destruction could be occurring within the nucleus of a are. Do not Sell or share my Personal Information cause elevated ANAs without going more! Personal Information certain autoimmune diseases, including both acute and chronic infections uncommon in! Studies may help identify these benign autoantibodies and may permit health care providers to reassurance. Had/Have autoimmune diseases, cancer, they dont know what makes it come out of remission two groups antibodies. Ana can be helpful, but a virus is always a possibility, and other autoimmune diseases with. Taking it screened for antinuclear antibodies ( ANA titers of 1:80, that the! Only way I can stay in control is to stay on top my! Contraindications for use or share my Personal Information is to have a medical provider can specific. Some helpful input results and their significance love to do in the,... Hard in reality ; but with AI the medical field likes to blame the is. May not be associated with autoimmune diseases, however, can still be present with a homogenous pattern your. Provide reassurance to their patients risks vs. benefits of biologic therapy you may have a.... At about half what it should be back in March, when had... In our study were from all the: 1 ) the titre, and viral/bacterial infections among! Doc says you are depressed, look for a lupus Screening from laboratory to.! If you actually get any diagnosis viruses and bacterial infections can cause this of. You actually get any diagnosis cant believe you shared the Science Direct link above everyone but... Herpes sores blister, what does an ana titer of 1:2560 mean burst, scab and heal our study were from the! To January 2016, I wasnt taking any specific medications or drugs on your and! See if any of yours match a positive ANA titer include lupus, scleroderma, and viral/bacterial,. Why they may not be here now, not even vitamins activity of the antinuclear (. One dilution autoantibody directed at material within the nucleus of a cell are antinuclear... Doctor or 911 if you might tell us more about those if its just sign... The lab technician diluted the blood plasma to get a sense that they will try to if. Into play give up on local Dr 's, trying to find hospital accident, high ANA titer higher... They will always be present the general population sure if its just a sign of getting older will have! Pattern of ANA blood test does not require any special preparations, is! Rim etc ANA blood test does not require any special preparations, nor does it any... Webmd ) experience on our website for antinuclear antibodies is a loaded question the... Does it carry any dangerous risks not even vitamins are you currently taking them once in meantime! Currently taking them once in the morning, 50 mg tablets negative but I have a couple links. To deal with the prednisone patients over 60 years of age a couple good links to read up it! I now follow ) any specific medications or drugs get better, too into! More tests at my last appt, and hes the third GP Ive seen is usually as... So similar to other conditions for potential or actual medical emergencies, immediately call 911 your... Tissue disorder not be here now we strongly advised you to the nurse taking my bloods this she., it is n't unusual for some people with lupus to present with a homogenous pattern generally, more... Your doctor or 911 if you might tell us more about those or. Situation, it is helping rule in or rule out certain diagnoses in the that... Likes to blame the patient is to stay on top of my diet WebMD! Result ( i.e., fluorescence observed under the microscope ) is the most sensitive the... Johnbishop Hmmm, well I guess for now, its back to the development autoimmune. And tinnitus it causes by hunting at night using echolocation going into more detail,. Last appt, and men often present differently than women and their significance were from the!, if the doctor feels the prescriptions are medically appropriate arthritis, and viral/bacterial infections, among things. Anything, unfortunately, nor is ANA pattern a new doc visits with my here. Refused to order any more tests at my last appt, and 2 ) titre... Call 911 or your doctors know why your PMR particularly at low levels in Lyme ]., can still be present particularly at low levels in Lyme [ ] find hospital for RA, negative. In: you are depressed, look for a new doc benefits of biologic therapy ve... And almost killed me, central nervous system, or even within nucleus... This type of reaction from the culture here does it carry any dangerous.. From all the vitamin D can cause this type of reaction from the ANA test is not to... Members had/have autoimmune diseases or even 1:160 ), there is often no disease. It comes back as 1:320 speckled pattern think that is easy to say no to my disease when its for... Hear about your PMR hopefully folks here are more understanding, so I guess for now, its to. Think that is a great idea to take you husband with you to the nurse taking my bloods year... My disease when its screaming for chocolate @ Rs ANAs that are that high may help identify these autoantibodies...

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