LabCorp and its Specialty Testing Group, a fully integrated portfolio of specialty and esoteric testing laboratories.
To detect and help diagnose certain autoimmune disorders, such as lupus and Sjögren syndrome, among other types
When a healthcare practitioner thinks that you have symptoms of certain autoimmune disorders
A blood sample drawn from a vein in your arm
None; however, certain medications can affect ANA test results, so tell your healthcare provider about any prescription medications, nonprescription medications, or street drugs you use.
Antinuclear antibodies (ANA) are a group of autoantibodies produced by a person's immune system when it fails to adequately distinguish between "self" and "nonself." The ANA test detects these autoantibodies in the blood.
ANA react with components of the body's own healthy cells and cause signs and symptoms such as tissue and organ inflammation, joint and muscle pain, and fatigue. ANA specifically target substances found in the nucleus of a cell, hence the name "antinuclear." They probably do not damage living cells because they cannot access their nuclei. However, ANA can cause damage to tissue by reacting with nuclear substances when they are released from injured or dying cells.
The ANA test is one of the primary tests for helping to diagnose a suspected autoimmune disorder or rule out other conditions with similar signs and symptoms. The ANA test may be positive with several autoimmune disorders. Patients with the autoimmune disorder systemic lupus erythematosus (SLE) are almost always positive for ANA, but the percentage of patients with other autoimmune disorders who have positive ANA results varies. Also, a significant number of patients with a variety of other types of disorders (and even some healthy people) may be positive for ANA, especially at low levels.
The antinuclear antibody (ANA) test is used as a primary test to help evaluate a person for autoimmune disorders that affect many tissues and organs throughout the body (systemic) and is most often used as one of the tests to help diagnose systemic lupus erythematosus (SLE). However, a positive ANA test by itself does not diagnose any one particular disease.
Depending on a person's signs and symptoms and the suspected disorder, ANA testing may be followed by additional tests for specific autoantibodies. Some of these tests are considered subsets of the general ANA test and detect the presence of autoantibodies that target specific substances within cell nuclei, including anti-dsDNA, anti-centromere, anti-nucleolar, anti-histone and anti-RNA antibodies. An extractable nuclear antigen (ENA) panel (anti-RNP, anti-Sm, anti-SS-A, anti-SS-B, Scl-70, anti-Jo-1) may also be used in follow up to a positive ANA.
These supplemental tests are used in conjunction with a person's clinical history and physical examination findings to help diagnose or rule out autoimmune disorders, such as Sjögren syndrome, polymyositis and scleroderma.
Different laboratories may use different test methods to detect ANA.
The ANA test is ordered when someone shows signs and symptoms that a healthcare practitioner suspects are due to a systemic autoimmune disorder. People with autoimmune disorders can have a variety of symptoms that are vague and non-specific and that change over time, progressively worsen, or alternate between periods of flare ups and remissions.
Some examples of signs and symptoms include:
A positive ANA test result means that autoantibodies are present. In a person with signs and symptoms, this suggests the presence of an autoimmune disease, but further evaluation is required to assist in making a final diagnosis. Again, some people without disease can have a positive ANA test.
Positive ANA test results may be reported in different ways, depending on the test method.
Amount of autoantibody present
Patterns of cellular fluorescence
In addition to a titer, positive results on IFA will include a description of the particular type of fluorescent pattern seen. Different patterns have been associated with different autoimmune disorders, although some overlap may occur. Some of the more common patterns include:
An example of a positive result using the IFA method would give the dilution titer and a description of the pattern, such as "Positive at 1:320 dilution with a homogenous pattern."
For either method, the higher the value reported, the more likely the result is a true positive.
Conditions associated with a positive ANA test
Other conditions in which a positive ANA test result may be seen include:
A healthcare practitioner must rely on test results, clinical symptoms, and the person's history for diagnosis. Because symptoms may come and go, it may take months or years to show a pattern that might suggest lupus or any of the other autoimmune diseases.
A negative ANA result makes lupus or another autoimmune disease unlikely diagnoses. It usually is not necessary to immediately repeat a negative ANA test; however, due to the episodic nature of autoimmune diseases, it may be worthwhile to repeat the ANA test at a future date if symptoms recur.
A person previously diagnosed with an autoimmune disease may have a negative ANA test if the condition is in a period of remission.
Aside from rare cases, further autoantibody (subset) testing is not necessary if a person has a negative ANA result.
ANA testing is not used to track or monitor the clinical course of lupus; thus, serial ANA tests for diagnosed patients are not commonly ordered once a diagnosis is established.
Some infections, autoimmune hepatitis and primary biliary cirrhosis as well as other conditions mentioned above can give a positive result for the ANA test.
Yes. About 3-5% of healthy individuals may be positive for ANA, and it may reach as high as 10-37% in healthy individuals over the age of 65 because ANA frequency increases with age. These would be considered false-positive results because they are not associated with an autoimmune disease. Such instances are more common in women than men.
ANA are autoantibodies that are directed against certain components found in the nucleus of a cell, hence the name "antinuclear." Some of the antibodies associated with autoimmune disorders may also be directed against substances in the cytoplasm and may be detected by the ANA test as well.
Autoimmune diseases often have a systemic effect on the body and are very complex by nature. Your healthcare provider will interpret what the test results mean for you and may need to compare your test results as well as the severity of your symptoms over a period of time in order to make a definitive diagnosis. This additional time may also allow your healthcare provider to eliminate other possible causes of your symptoms.
Your healthcare practitioner may also order laboratory tests that detect the presence of inflammation, such as erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP). A test for total immunoglobulins may be used to evaluate a person with SLE and a complement test may be done to monitor the course of the disease.
Sources Used in Current Review
(December 28, 2017) Mayo Clinic Staff. ANA test. Available online at https://www.mayoclinic.org/tests-procedures/ana-test/about/pac-20385204. Accessed on March 23, 2018.
American College of Rheumatology. Antinuclear antibodies (ANA). Available online at: https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Antinuclear-Antibodies-ANA. Accessed on March 23, 2018.
Petri M, Orbai A, Alarcon GS, et al. Derivation and validation of Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012 August ; 64(8): 2677–2686. doi:10.1002/art.34473. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409311/pdf/nihms-365115.pdf. Accessed on March 27, 2018.
Pagana, Kathleen D., Pagana, Timothy J., and Pagana, Theresa N. (© 2015). Mosby's Diagnostic and Laboratory Test Reference 12th Edition: Mosby, Inc., Saint Louis, MO. Pp 87-89.
(September 4, 2014) Al-Zougbi A, Griffing GT. Antinuclear antibody. Available online at https://emedicine.medscape.com/article/2086616-overview. Accessed on March 23, 2018.
(July 11, 2013). Kassan S. What you need to know about Sjogrens syndrome. Available online at: https://resources.lupus.org/entry/what-you-need-to-know-about-sjögrens-syndrome. Accessed March 25, 2018.
Patel R, Shahan A. Epidemiology of Sjogren’s syndrome. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4122257/pdf/clep-6-247.pdf. Accessed on March 25, 2018.
February 11, 2018) Ranatunga SK. Sjogren syndrome workup. Available online at https://emedicine.medscape.com/article/332125-workup#c7. Accessed March 25, 2018.
Sources Used in Previous Reviews
The Gale Encyclopedia of Medicine: Antinuclear antibody test. Available online at http://www.findarticles.com/p/articles/mi_g2601.
Kavanaugh A, Tomar R, Reveille J, Solomon DH, Homburger HA. Guidelines for clinical use of the antinuclear antibody test and tests for specific autoantibodies to nuclear antigens. Archives of Pathology and Laboratory Medicine, 2000, 124(1): 71-81.
Steven Lobel, PhD, D-ABMLI, MBA. Laboratory Director, Quest Diagnostics, Baltimore, MD.
H. James Williams, MD. Professor of Medicine, Thomas E. and Rebecca D. Jeremy Presidential Endowed Chair for Arthritis Research, University of Utah School of Medicine, Salt Lake City, UT.
Pagana, Kathleen D. & Pagana, Timothy J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 90-92.
Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].
Reeves, W. (2006 July). Fluorescent Antinuclear Antibody (FANA) Test: "False Positive." American College of Rheumatology [On-line information]. Available online at http://www.rheumatology.org/public/factsheets/fana.asp. Accessed on 4/9/07.
Fosam, H. (2006 April 24). The Many Faces of Lupus: An Expert Interview With Stephen Paget, MD. From Medscape Rheumatology, Expert Interview 2006;8(1) [On-line information]. Available online at http://www.medscape.com/viewarticle/529590. Accessed on 4/9/07.
Relchlin, M. (2005 February 3, Updated). Laboratory Tests Used in the Diagnosis of Lupus. Lupus Foundation of America [On-line information]. Available online at http://www.lupus.org/education/brochures/labtests.html.
(2003 August, Revised). Systemic Lupus Erythematosus. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Handout on Health [On-line information]. Available online at http://www.niams.nih.gov/hi/topics/lupus/slehandout/. Accessed on 4/15/07.
Bylund DJ, Nakamura RM: Organ-specific autoimmune diseases, in Henry's Clinical Diagnosis and Management by Laboratory Methods, 21st ed. Richard McPherson and Matthew Pincus, eds. Saunders Elsievier: Philadelphia. Pp 945-960, 2007.
Peter JB. Antinuclear antibodies, in Use and Interpretation of Laboratory Tests in Rheumatiology, James B Peter, ed. Speciality Laboratories: Los Angeles. Pp 10-11, 1998.
Smalley DL. Autoimmune diseases, in Clinical Laboratory Utilization and Consultation, BG Davis, D Mass, ML Bishop, eds. WB Saunders: Philadelphia. Pp 467-483, 1999.
Pagana, Kathleen D. & Pagana, Timothy J. (2006). Mosby's Manual of Diagnostic and Laboratory Tests 3rd Edition: Mosby Elsevier, Saint Louis, MO. Pp 91-93.
Burtis C, Ashwood E, Bruns D, eds. (2006). Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, 4th edition, Saunders, Elsevier.
Arbuckle MR et al. Development of autoantibodies before the clinical onset of systemic lupus erythematosus. N Engl J Med 2003 Oct 16; 349:1526-33.
Shmerling RH. Autoantibodies in systemic lupus erythematosus -- there before you know it. N Engl J Med 2003 Oct 16; 349:1499-500.
Borigini, M. (Updated 2009 February 3). Antinuclear antibody panel. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003535.htm. Accessed June 2010.
Von Feldt, J. (Updated 2009 April). Antinuclear Antibodies (ANA). American College of Rheumatology [On-line information]. Available online at http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/ana.asp. Accessed June 2010.
(2009 April). Handout on Health: Systemic Lupus Erythematosus. National Institute of Arthritis and Musculoskeletal and Skin Diseases [On-line information]. Available online at http://www.niams.nih.gov/Health_Info/Lupus/default.asp. Accessed June 2010.
(Updated 2009 August). Connective Tissue Diseases. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/ConnectiveTissueDz.html#. Accessed June 2010.
Arthur Kavanaugh, MD, Russell Tomar, MD, John Reveille, MD, Daniel H. Solomon, MD, MPH, and Henry A. Homburger, MD. Guidelines for Clinical Use of the Antinuclear Antibody Test and Tests for Specific Autoantibodies to Nuclear Antigens. Arch Pathol Lab Med 124(1):71-81, 2000.
Jacobs DS, DeMott WR, Oxley DK, eds. Laboratory Test Handbook, 5th ed. LexiComp: Cleveland, Pp 507-509, 2001.
Antinuclear Antibody Panel. (Updated Feb. 3, 2014.) MedlinePlus Medical Encyclopedia. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003535.htm. Accessed February 2014.
Von Feldt, J. M. (Updated Feb. 2012.) Antinuclear Antibodies (ANA). American College of Rheumatology. Available online at http://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Antinuclear_Antibodies_(ANA)/. Accessed February 2014.
Abelson, A. et al. Laboratory Evaluation of Rheumatic Diseases. The Cleveland Clinic Foundation. Available online at http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/rheumatology/laboratory-evaluation-rheumatic-diseases/. Accessed February 2014.
Test ID: ANA2 Antinuclear Antibodies (ANA), Serum. Mayo Clinic. Available online at http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/9026. Accessed February 2014.
National Institute of Arthritis and Musculodkeletal and Skin Diseases. Questions and Answers About Arthritis and Rheumatic Diseases. Available online at http://www.niams.nih.gov/Health_Info/Arthritis/arthritis_rheumatic_qa.asp. Accessed April 2014.