Positive Anti-Nuclear Antibody (ANA) Test
Systemic lupus erythematosus (SLE): when active, usually a homogenous pattern on ANA or less commonly speckled, rim, or nucleolar when present in high enough titer to be clinically significant
Sjögren syndrome: common ANA pattern is speckled; less commonly homogenous
Scleroderma or systemic sclerosis: ANA pattern is most commonly speckled, followed by centromeric and less commonly nucleolar
Mixed connective tissue disease: ANA pattern is almost always speckled
Rheumatoid arthritis (RA): when ANA positive (about 25-40% of cases), a speckled ANA pattern most commonly
Don't Miss - Dangerous Situations
These are all chronic diseases, and, if there is a life-threatening complication, the complication could be serious.
Commonly Encountered Situations
Common autoimmune disorder
Much more common in women than men (female:male ratio approximately 9:1)
Suggested Additional Lab Testing
For follow-up from a positive ANA test:
For SLE: anti Ds DNA, anti-SS-A (Ro), anti-SS-B (La), anti-U1 RNP, anti-Sm, and follow-up with serial anti-DS DNA
For Sjögren syndrome: anti-SS-A (Ro), anti-SS-B (La)
For polymyositis and adult dermatomyositis: anti-Jo-1
For mixed connected tissue disease: test for anti-U1 RNP
For scleroderma: if there is a fine or grainy nuclear pattern, test anti-Scl-70 (topoisomerase I); if there is a centromeric pattern, no additional tests are recommended.
In addition to the follow-up with serologic testing, patients with Sjögren syndrome can be tested for dry eyes and dry mouth by a variety of assays.
Patients with possible inflammatory muscle disease may benefit from creatine kinase testing and/or a muscle biopsy. Evaluation for RA: rheumatoid factor test (found in approximately 80% of patients with RA); x-rays, particularly of hand and wrist for joint disease; C-reactive protein test as an indicator of inflammation with or without SED rate to assess level of inflammation.
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.