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- Patient Comments: Antinuclear Antibody Test - Testing
- Patient Comments: Antinuclear Antibody Test - Diagnosis
- What are antinuclear antibodies?
- How is the ANA test designed? How is the procedure performed?
- What is the interpretation of the ANA test result?
- What are autoimmune diseases?
- What other conditions cause ANAs to be produced?
- Can medications cause ANAs to be produced?
- ANAs are defined as having patterns. What does this mean?
- Are ANAs always associated with illness? What is the normal range?
What other conditions cause ANAs to be produced?
ANAs can be produced in patients with infections (virus or bacteria), lung diseases (primary pulmonary fibrosis, pulmonary hypertension), gastrointestinal diseases (ulcerative colitis, Crohn's disease, primary biliary cirrhosis, alcoholic liver disease), hormonal diseases (Hashimoto's autoimmune thyroiditis, Grave's disease), blood diseases (idiopathic thrombocytopenic purpura, hemolytic anemia), cancers (melanoma, breast, lung, kidney, ovarian and others), skin diseases (psoriasis, pemphigus), as well as in the elderly and those people with a family history of rheumatic diseases.
Can medications cause ANAs to be produced?
Many medications can sometimes stimulate the production of ANAs, including procainamide (Procan SR), hydralazine (Apresoline), and phenytoin (Dilantin). ANAs that are stimulated by medication are referred to as drug-induced ANAs. This does not necessarily mean that any disease is present when these ANAs are "induced." Sometimes diseases are associated with these ANAs, and they are referred to as drug-induced diseases.
ANAs are defined as having patterns. What does this mean?
ANAs present different "patterns" depending on the staining of the cell nucleus in the laboratory: homogeneous or diffuse pattern; speckled pattern; nucleolar pattern; and peripheral or rim pattern. While these patterns are not specific for any one illness, certain illnesses can more frequently be associated with one pattern or another. The patterns then can sometimes give the doctor further clues as to types of illnesses to look for in evaluating a patient. For example, the nucleolar pattern is more commonly seen in the disease scleroderma. The speckled pattern is seen in many conditions and in people who do not have any autoimmune disease. These patterns are determined by technical experts who routinely interpret the tests.
Are ANAs always associated with illness? What is the normal range?
No. ANAs can be found in approximately 5% of the normal population, usually in low titers (low levels). These people usually have no disease. Titers of 1:80 or lower are less likely to be significant. (ANA titers of less than or equal to 1:40 are considered negative.) Even higher titers are often insignificant in patients over 60 years of age. Ultimately, the ANA result must be interpreted in the specific context of an individual patient's symptoms, underlying medical conditions, and other test results. It may or may not be significant, even if positive, in a given individual.
"ANA." Lab Tests Online. Feb. 24, 2015. <http://labtestsonline.org/understanding/analytes/ana/tab/test/>.
Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia: Lippincott Williams & Wilkins, 2003.
Kelley's Textbook of Rheumatology, W B Saunders Co, edited by Shaun Ruddy, et al., 2000.
Shiel, WC, et al. The Diagnostic Associations of Patients With Antinuclear Antibodies Referred to a Community Rheumatologist, J Rheumatology 1989;16:782-5.