The test

The ANA test is straightforward: a blood sample is taken, then tested for the presence of autoantibodies. Autoantibodies may attack different parts of a cell, but the ANA test is particularly good at detecting those that attack the cell nucleus.

Is the test accurate?

Not especially. A positive result is only an indication of the likelihood of your having the disease – it is not a definite confirmation of its presence.

The ANA test result is reported as a titre – a measure of how much the blood sample can be diluted and yet still show the presence of antibodies. The higher the titre, the more likely the presence of a connective tissue disorder such as SLE (Postgrad Med, 1993; 94: 55-66).

But what constitutes a positive result? In some studies, a titre of less than 1 in 40 was regarded as a positive result. However, a higher titre is usually considered more conclusive. For example, a titre of 1 in 80 suggests that an autoimmune disease is highly likely, and at least one commercial lab (Arup Laboratories, owned by the University of Utah) states in its guidelines that only titres of 1 in 160 or higher are to be considered significant positives.

How specific is the test?

At best, a positive ANA test only tells the doctor that there’s a likelihood of connective tissue disease, but it can’t tell you which one as a number of such conditions will produce a positive result. Whereas 95 per cent of SLE sufferers will test positive with the ANA (Rheum Dis Clin North Am, 1990; 16: 617-39), only 30-50 per cent of those with rheumatoid arthritis, 40-70 per cent with Sjögren’s syndrome, 60-80 per cent with scleroderma and 20-50 per cent with chronic juvenile arthritis will (Arch Pathol Lab Med, 1999; 124: 71-81).

Healthy people can also show a positive result: around 2 per cent of the population have mildly elevated antibodies without symptoms (Adv Immunol, 1989; 44: 93-151). One study involving 15 international laboratories found that ANA tests of the general population were positive in 32 per cent of cases at a titre of 1 in 40, and in 5 per cent of people at a dilution of 1 in 160 (Arthritis Rheum, 1982; 25: 1271-7).

Drugs used to treat other disorders, such as procainamide (for heart arrhythmias), hydralazine (a vasodilator) and even the tetanus vaccine can return a positive result (Science, 1994; 266: 810-3), as can a form of lupus that is drug-induced.

Viral or bacterial infections, lung diseases (such as pulmonary hypertension), ulcerative colitis, cancers (of the skin, breast, lung and kidney) and even skin conditions like psoriasis can cause an increase in the number of antibodies produced.

Diagnosis is further complicated by the considerable overlap in symptoms of many connective-tissue diseases as well as the presence of various antibodies. For example, ‘mixed connective-tissue disease’ displays the symptoms of SLE, scleroderma and myositis, leading some to ask whether this is truly a separate entity at all (Arthritis Rheum, 1998; 41: 768-77).

Moreover, there is a high potential for false negatives (an all-clear result when you have the disease.) As autoimmune disorders often evolve over time, a significant number of patients produce negative ANA tests early on (Arthritis Rheum, 1999; 42: 1785-96), and only repeat testing at a later date can verify the disease status (Arch Pathol Lab Med, 1999; 124: 71-81).

Yet more inaccurate tests

If your ANA test results are positive, another set of tests can be ordered to differentiate between diseases by looking at specific nuclear proteins. But these tests are also low in sensitivity. So, while a positive result for double-stranded DNA and SM antibodies may confirm SLE, a negative test doesn’t necessarily rule it out (Arch Pathol Lab Med, 1999; 124: 71-81).

Although these tests are not harmful in themselves, their biggest danger is their huge room for error. An incorrect diagnosis can set you off on a treatment you don’t need, often requiring drugs with debilitating side-effects of their own.

Apparently these patients have a deficiency of several antioxidants. Therefore, there has been some success using a combination called Bioantox, which has trace elements of selenium in combination with amino-acid methionine and antioxidant vitamins C and E.

According to Dr Leach of The Regional Drug Information Service and Dr Braganza of the Pancreato-Biliary Service, both based in Manchester, this preparation allows a substantial reduction in the intake of daily tablets.

Also, on the subject of scleroderma, I have heard there have been good results in the United States, with griseofulvin (an antifungal). I have read in Townsend Letter for Doctors & Patients (Dec 1997) that autoimmune disease may be linked to mycoplasma and respond to antibiotics (doxycycline, ciprofloxacin).

I have also read in Eat Right For Your Body Type by P. D’Adamo that autoimmune problems stem from eating a diet incompatible with your blood group. Accounts of people reversing an autoimmune condition are posted on the author’s website (www.dadamo.com).- Jim Byrne, Liverpool.

A:Scleroderma, which means “hard” skin, is an autoimmune disease in which the skin becomes fibrotic swollen, thickened and hardened and ultimately scarred due to rampant overproduction of the protein collagen. Initially, the tightened skin may occur rapidly, create a burning sensation due to the increase in pressure in the skin and rubbing against the muscles and tendons below it. Characteristically, thick waxy patches come and go and, if large enough, restrict movement. This fibrosis, which follows the chronic inflammation of the skin in scleroderma, may also affect and ultimately damage arteries, joints and internal organs like the lungs, the heart muscle, the esophagus and the kidneys. The concern is especially for lung tissue inflammation, which often necessitates immediate treatment with drugs. Anyone suffering this disease often has a mask-like appearance.

Scleroderma is strikes three times as many women as men, usually between 30 and 60. It’s also relatively common, affecting 100,000 people in the US alone.

Scleroderma may also be accompanied by vascular symptoms called Raynaud’s syndrome, where blood flow to the extremities is turned on and off, the extremities turn white and then purple blue or red, and the sufferer experiences tingling, burning and pain. It may also affect the blood vessels around the nerves of the esophagus, causing problems swallowing food. The repeated stop-start aspect of blood flow produces toxic byproducts of oxygen, which ultimately damage tissue.

Medicine tends to treat this puzzling triad of illnesses by treating the symptoms of each. For the fibrotic skin, particularly when it involves the chest or abdomen, doctors tend to prescribe Cuprimine (D-penicillamine) and methotrexate, an all purpose, highly potent drug often used in conditions like arthritis which started life as chemotherapy for lymphomas and leukemia. Nevertheless, no drug has yet been shown to correct skin hardness that is already there, only to attempt to stop the progression of the disease. Oral steroids are also used if there is inflammatory muscle disease. If doctors even suspect that there is lung fibrosis, they are usually quick to prescribe cyclophosphamide (Cyproxin).

All such drugs have a remarkable litany of side effects, as they wear another hat as chemotherapy. Methotrexate, for instance, can decrease your resistance to infection, cause mouth ulcers and nausea, anemia, black stools, blurred vision, changes in skin coloration, convulsions, hair loss, infertility, intestinal inflammation, kidney failure, paralysis (including complete paralysis), intestinal ulcers, bleeding and vomiting blood. Cytoxan (cyclophosphamide), another anti-cancer drug, used for breast cancer, leukemias and lymphomas, can cause bladder damage, inflamed colon, decreased sperm count, impaired wound healing, new tumour growth, temporary hair loss, prolonged or temporary sterility in men, failure to menstruate and yellowing of eyes and skin. Penicillamine’s listing in the US Physicians’ Desk Reference starts off with a large box encouraging doctors who plan to use this drug to thoroughly familiarize themselves with its toxicity and special dosage considerations. “Penicillamine should never be used casually,” it says. No wonder. As a last-ditch remedy for arthritis that hasn’t responded to anything else, penicillamine can kill patients who go on to develop aplastic anemia, agranulocytosis, thrombocytopenia, and other conditions. Serious blood or kidney adverse reactions can occur at any time. And of course the side effects of steroids, well known and otherwise, have been covered in depth in WDDTY (see vol 7 no 2).

Thankfully, not all treatments involve such life-or-death medication. Doctors also recommend that patients with scleroderma have occupational and physical therapy to prevent or help permanent contracture of the fingers, and to wear gloves while performing many physical tasks like washing the dishes, to avoid breaking the skin.

For Raynaud’s phenomenon, medicine tends to use medications that expand the blood vessels. The most common vasodilators include drugs like Procardia, also used if there are pulmonary artery problems. Procardia can cause lightheadedess, mood changes, headache, nausea, swelling of arms, legs, hands and feet, tremors, wheezing, blurred vision, abdominal pain, chest congestion, insomnia, general chest pain, impotence, joint pain, muscle and bone inflammation, sexual difficulties, shortness of breath, and pins and needles. It may cause muscle and bone inflammation, which may lead one to mistake a drug side effect for an effect of the illness.

Besides drugs, those with Raynaud’s should preserve body heat by dressing in multiple layers of clothing, and wearing gloves, hats and scarves.

Although medicine usually draws a blank about the cause of this illness, abnormal metal status is the latest and most interesting theory, according to a breakthrough discovery by researchers at Johns Hopkins University in a study of 60 patients. Antony Rosen, a researcher based at Johns Hopkins, headed up a group that found that the toxic oxygen products caused by interrupted blood flow damage tissue, but only when there is an abnormal amount of iron, copper, zinc or other metals present in the body. When the body treats these molecules as foreign invaders, scleroderma results (J Experimental Med, 1997; 185: 71-80). This means that environmental exposure to metal may be an important trigger, says Rosen (Lancet, 1997; 349: 107). Rosen says his team are now trying to understand the factors responsible for abnormal cellular metal accumulation. It may well be that even abnormal processing of minerals or other nutrient imbalances are ultimately found to be the culprit.

Besides these drugs, a number of other nutrients have shown promise in treating this puzzling condition. In one small experimental study, patients with sclerosis and patches of scleroderma improved after taking vitamin E supplements (Cutis, 1973; 11: 54-62). University of California at Los Angeles assistant professor and WDDTY panelist Dr Melvyn Werbach recommends that patients take 800 IU of vitamin E 15 minutes before meals, increasing to 1600 IU if needed and then decreasing to a maintenance dosage. He also notes that you should avoid taking iron at the same time (Nutritional Influences on Illness: A Sourcebook of Clinical Research, Third Line Press, Tarzana, California, 1996).

Werbach has also found that omega-6 fatty acids can help. In one study, four patients suffering from scleroderma for up to 13 years given 1 gram of EPO three times a day reported relief of pain in the extremities, improvement of skin texture, telangiectasia (widening of capillaries and small veins, a condition of this illness) (Br J Clin Pract, Nov/Dec 1985).

The B vitamin PABA may also soften the skin, says Werbach. In one study, 90 per cent of a group of 224 patients given PABA experienced skin softening (some markedly so), while less than a fifth of those not given the B vitamin experienced mild to moderate improvement (Clin Exp Rheumatol, 1988; 6: 261-68) results that were repeated in another double-blind study (Arthritis Rheum, 1966; 9: 495). In another study of 135 patients whose scleroderma was spread throughout their bodies, every patient experienced softening of the sclerotic skin, so long as treatment was continued for three months. Some patients experienced complete resolution of symptoms and were able to discontinue treatment. The only failure was a patient whose affected skin, which was rockhard, covered most of his body. PABA has also been shown to help longevity in these patients. In one study, those receiving the B supplement live significantly longer, with more than three-quarters living at least 10 years (J Clinical Epidemiology, 1988; 41: 193-204).

Besides these nutritional remedies, Dr Werbach knows of a number of herbal remedies known to soften scleroderma.

The enzyme bromelain obtained from the pineapple has anecdotal evidence of being able to reverse many of the effects of scleroderma; in one case, a patient was able to clench her fist, eat normally and sleep in a reclining position (J Natl Med Assoc, 1964; 56: 272-3). Trademarked derived fractions of the herb Centella asiatica (known as Gota kola) have been tested experimentally; in one case using the total triterpenoid fraction of Centella asiatica (TTFCA), the herb worked 85 per cent of the time (Acta Diabetol Lat, 1972, 52: 141-50).

Another substance called piascldine, which is an extract from avocado and soy bean oils, normally preserved in an alcohol solution (made by Pharmascience in France), has good evidence of improving symptoms of scleroderma and Raynaud’s phenomenon. In one study of 50 patients, half showed improvement in symptoms of scleroderma. All the patients with Raynaud’s syndrome had better finger movement and ability to adapt to the cold (J Presse Med, 1970; 78: 1235-6). Ginkgo biloba, vitamin E, magnesium, niacin and the elimination of any allergies can also help Raynaud’s (see Proof! vol 1 no 3).

Of 24 patients with silicone gel breast implants, 11 had symptoms of autoimmune disease. Of these 11, the majority (seven) had scleroderma, and the rest had systemic lupus erythematosus, rheumatoid arthritis or multiple autoimmune diseases.

All 11 had a high level of “antinuclear” antibodies, which are associated with the development of autoimmune complications in women with breast implants.

Rupture of the implant apparently hastened the onset of symptoms.

Interestingly, scleroderma in particular has been frequently linked to occupational hazards such as coal mining, exposure in gold mining to silica dust and handling polyvinyl components in factories.

I also believe that the current violent behaviour – terrorism, road rage and the like – are due to thought waves transmitted via the Field and picked up by receptive individuals who then, via their own thought transmissions, influence others. This would account for crowd violence and riots, where normally inoffensive people are drawn into situations they would usually avoid.

The reason for this letter is to tell you about a new arthritis treatment. There is a plant I have learned about from one of my clients, David Cowles, a businessman who lives in Las Vegas. If you log on to http://www.nesgadol.com, you can download his essay on marsh pennywort (Hydrocotyle umbellata).

He is trying to find someone who will analyse the plant to discover its constituents because he has discovered that it has remarkable curative powers. He has cured himself of arthritis, gout, scleroderma, emphysema and Raynaud’s disease. It heals the kidneys, too.

His wife, who suffered from cystitis for 30 years – which no amount of expensive medical treatment had managed to cure – ate just two leaves of pennywort a day and, after five weeks, she was completely cured.

Finally, Russ Maslen, the author of the book Arthritis BC: Before Centella that I published, has discovered that he is suffering from pancreatic cancer. But because he has been eating Centella asiatica (gotu kola) leaves for the past 11 years, the tumour has stopped growing and is now about the size of a walnut.

His oncologist thinks he may have had this tumour all that time and – get this – Russ has foregone all forms of conventional therapy, has not lost weight and is still functioning normally. When I met him recently at his home in New South Wales, Australia, he was fit enough to take my son and me out and about to show us the sights. – Kenneth V. Jackson, Centella Probe (UK), via e-mail