Antinuclear Antibody Test (ANA)

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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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.

REFERENCES:

"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.

Medically Reviewed by a Doctor on 5/18/2016

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