Most lupus patients are familiar with the dsDNA antibody blood test. Like the ANA result, it is a blood test most closely related to lupus. Occasionally a positive dsDNA result can be seen in other conditions. But, the presence of a dsDNA antibody is considered specific for a diagnosis of lupus. As there are multiple ways a lab may detect a dsDNA, there still remains the possibility of a false positive, but a positive dsDNA result warrants a trip to the rheumatologist. (Reminder = “false positive” simply means the test is positive, yet the patient doesn’t have the condition associated with that result) Patients often are referred to a rheumatologist with a notebook full of labs, mostly of all varieties of antibodies and it is overwhelming.
The dsDNA antibody is an antibody against the double stranded DNA that is found in all of our cells. By definition, it is considered an “anti-nuclear antibody.” It is very rare to have a negative ANA result yet a positive dsDNA antibody. It is most closely related to Lupus but it can also be seen in Sjogren’s Syndrome or Scleroderma.
What a dsDNA result means
When a diagnosis of lupus is established, the presence of a dsDNA gives the doctor much needed information. The development of kidney disease in lupus, something that needs to be caught early in order to avoid any permanent damage, is closely tied to the presence of a dsDNA. It is also a blood marker that tells the doctor if a patient’s lupus is active. As opposed to the ANA or RF, the dsDNA is repeated, usually at every rheumatology appointment. The dsDNA antibody level goes up and down according to the lupus activity; high dsDNA is related to high lupus activity and low levels with low activity. Because the dsDNA antibody has been implicated in the development of lupus, striving for low or negative dsDNA level makes common sense. But rheumatology and common sense rarely live together! And just like most things in Rheumatology, there are always exceptions.
What to do with a high dsDNA
The text books teach us that a high dsDNA indicates high lupus activity. But patients aren’t text books and we need flexibility when dealing with actual lupus patients. There are plenty of times when patients will, by all accounts, be doing well, yet still have an elevated dsDNA. What do we do then? Each rheumatologist will likely approach this differently, but I always like to individualize the treatment based on the patient. The patient’s personal history with lupus and their health goals become a part of the conversation before blindly increasing or adding medications simply because a lab is abnormal. The opposite is true as well. Far too often, lupus patients are told they are “fine” because labs, such as the dsDNA, are normal. Yet the patient may still be suffering from more subtle, yet still disabling, symptoms, such as fatigue, pain and brain fog.
Labs such as the dsDNA antibody test are tools used to better understand an individual’s lupus. It can help us examine their risk for complications such as kidney disease and alert us to when a flare may be imminent. But it is simply one tool rheumatologists have and appropriate emphasis should be placed on it.
In good health,