ANA Testing Pathology Quick Guide



3683635-181610Pathology Improvement Programme 2017/18Quick Guide for General Practice: Anti-nuclear Antibody (ANA) TestingClinical SituationRecommendationSourceSuspected SLE (systemic lupus erythematosus)ANA should be requested.But remember:ANA is NOT specific for SLE There are 11 diagnostic criteria for SLEANA is only one (maybe 2) of the diagnostic criteria for SLESLE diagnostic criteria - looking for 4/11Malar rash: butterfly-shaped rash across cheeks and noseDiscoid (skin) rash: raised red patchesPhotosensitivity: skin rash as result of unusual reaction to sunlightMouth or nose ulcers: usually painlessArthritis (nonerosive) in two or more joints, along with tenderness, swelling, or effusion. With nonerosive arthritis, the bones around joints don’t get destroyed.Cardio-pulmonary involvement: inflammation of the lining around the heart (pericarditis) and/or lungs (pleuritis)Neurologic disorder: seizures and/or psychosisRenal (kidney) disorder: excessive protein in the urine, or cellular casts in the urineHematologic (blood) disorder: hemolytic anemia, low white blood cell count, or low platelet countImmunologic disorder: antibodies to double stranded DNA, antibodies to Sm, or antibodies to cardiolipinAntinuclear antibodies (ANA): a positive test in the absence of drugs known to induce it. A positive ANA in a patient who you do not think has SLE and who only has 1 of the diagnostic symptoms is most likely to be a NON-SPECIFIC FINDING.ANA alone has a low positive predictive value for SLE so it is unlikely to be useful in patient populations with a low prevalence of systemic lupus erythematosus (e.g. the elderly).A negative ANA test does not rule out systemic lupus erythematosus – if you have strong clinical indications, contact the lab for further testing.Guidelines developed by Dr. Joanna Sheldon, Immunology Clinical Lead, St. George’s HospitalSuspected:Sjogren’sSystemic sclerosisCRESTANA should be requested.Conditions that also give positive ANAs:Autoimmune rheumatic e.g. SLE, RA, Sjogrens, MCTDInfections e.g. especially viral but also or bacterial, HIV, HepB/C, EBV etc.Respiratory e.g. pulmonary fibrosis, pulmonary hypertensionGastro e,g, ulcerative colitis, Crohn's, primary biliary cirrhosis, alcoholic liver diseaseEndocrine e,g, autoimmune hypo- and hyper- thyroiditisBlood e.g. Idiopathic thrombocytopenic purpura, hemolytic anemiaMalignancy e.g. melanoma, breast, lung, kidney, ovarian etc.Skin diseases e.g. psoriasis, pemphigusSilicone gel implantsThe elderlySubjects with a family history of rheumatic diseases.Drugs: Isoniazid, Hydralazine, Procainamide, Anti-convulsants, Capoten, Chlorpromazine, etanercept, infliximab and adalimumab, Methyldopa, Minocycline, Penicillamine, Quinidine, SulfasalazineThese recommendations represent best practice in the consensus of opinion of the authors and reviewers. The guide is not to be used for the diagnosis or treatment of medical conditions. The authors have used all reasonable care in compiling the information but make no warranty as to its accuracy. The information contained in the guide is designed to be used only for educational and informational purposes only. ................
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