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Referral & assessment
Approach to a Positive ANA
A practical way to interpret ANA results and decide what comes next.
Video lesson
Key points
ANA is sensitive but not specific. Up to 15% of healthy people are positive at 1:40 to 1:80, rising with age. Titer of 1:160 or higher and a compatible pattern raise the likelihood of connective tissue disease.
Practical approach
Order ANA only with a clinical question: rash, inflammatory arthritis, cytopenias, serositis, Raynaud’s with skin changes, unexplained proteinuria or sicca. If positive with symptoms, follow with ENA panel, anti-dsDNA, complements, CBC and urinalysis.
Pearls
Repeating a positive ANA adds nothing. A dense fine speckled (DFS70) pattern alone usually argues against systemic autoimmune disease.
At a glance
Category
Referral & assessment
Reviewed by Farhan Tahir, MD, FACR
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