Powered By
Continue with Facebook
Sign up with your email
“I’ve had two ANA tests in the last month, and they are showing different results. I don’t know what to make of this!” shared a MyLupusTeam member. An antinuclear antibody (ANA) test is often the first step doctors take when checking for lupus. It’s a blood test that can help diagnose and monitor the progression of lupus. But sometimes, the results can be confusing.
Keep reading to learn what ANA results mean and why they may not always look the same.
Lupus is an autoimmune disease in which a person’s immune system attacks their own cells and tissues. Normally, the immune system makes antibodies — proteins that bind to foreign organisms like bacteria or viruses — to get rid of them.
The most common type of lupus is systemic lupus erythematosus (SLE). In SLE, the immune system mistakenly produces antibodies against the body’s own tissues. These antibodies are called autoantibodies. When autoantibodies accumulate in the body, it leads to inflammation and organ damage, often seen in people with SLE.
It’s normal to have some autoantibodies in your blood, even if you don’t have lupus. Your ANA levels alone can’t prove that you have lupus or any other autoimmune disease. The production of ANAs in the body increases as age advances. In healthy people, the immune system typically identifies and removes ANAs before they can cause harm. When there are more ANAs in the body than normal, it means the body’s self-check system isn’t working as it should. If this continues and the immune system has the right conditions to overreact, it can lead to symptoms of autoimmune diseases like lupus.
More than 95 percent of people with SLE have ANAs in their blood. ANAs recognize parts of the nucleus. Nuclei are structures in the cell that contain genetic material. Because ANAs are so common in people with SLE, doctors often use them to help diagnose the condition.
If you have symptoms of SLE or another autoimmune disease, your doctor may order an ANA test to measure the level of these antibodies in your blood. The test is done with a simple blood draw, and your doctor will look at the results in the context of your overall health and medical history.
A positive test result includes two parts — the titer and the staining pattern. The titer shows the level of ANAs in the sample. It’s reported as a ratio. Generally, a ratio greater than or equal to 1:80 is considered to be a positive ANA sample.
The ANA pattern refers to how the antibodies bind to parts of the cell nucleus, producing different staining patterns under the microscope, such as:
Understanding your staining patterns can be complicated. Your doctor can use these results as part of the bigger picture of how lupus may affect your body. For example, some research from Frontiers in Immunology shows that people with SLE who have peripheral, speckled, or mixed staining patterns have a higher risk of organ damage and severe lupus symptoms. However, more research is needed before drawing strong conclusions from patterns alone. ANA test results should always be interpreted alongside a person’s symptoms. A positive ANA test result without symptoms doesn’t mean much, so this test can’t be used as a general screening tool.
If you have lupus, your ANA test results — including titer and pattern — may change over time due to disease activity, overlapping conditions, or treatment.
ANAs can also show up in people with other autoimmune diseases, including rheumatoid arthritis, Sjögren’s disease, and scleroderma. Many people with SLE have one or several of these other conditions, so their ANA test results may show mixed patterns. One member of MyLupusTeam shared, “When I was told I had lupus five months ago, I was told that I have eight other patterns from the autoimmune spectrum.”
Certain ANA patterns are found at a higher rate in people with more severe lupus. Researchers have found that peripheral, speckled, and mixed staining ANA patterns in individuals with SLE may have a higher likelihood of being associated with severe disease and organ damage. Specific ANA patterns are associated with higher levels of proteins that become activated in active SLE.
The patterns of ANAs have also been shown to change over time, depending on whether you’re in a lupus flare and whether you’re undergoing treatment. For example, a person with active disease or a flare may have a peripheral, speckled, or mixed pattern of the two. As they undergo treatment with steroids or other immunosuppressants, their ANA pattern may become homogeneous, meaning the staining appears smooth and evenly distributed across the entire nucleus.
The ANA pattern alone can’t be used to tell how active the disease is. It needs to be compared with symptoms, physical examination results, and other laboratory tests to see if they match or are related.
Your rheumatologist can give you more information about what may be affecting your ANA test results based on your personal characteristics, medical history, and any treatments you’ve had.
While the ANA test provides valuable information about the levels and locations of ANAs, it has limitations for use in the diagnosis of SLE:
The results of the ANA test shouldn’t be used alone to diagnose SLE. They need to be verified by additional testing to make an accurate SLE diagnosis. If you test positive, your doctor will order an ANA panel to confirm a lupus diagnosis.
An ANA panel checks for different types of autoantibodies (described below) in your blood sample. The results of ANA and ANA panel tests only make sense when considered alongside your symptoms. Some of these panel markers may be positive after an infection and disappear later. That’s why it’s important to have ANA tests done under the guidance of your healthcare provider and to talk with them about what the results mean for you.
Found in 68 percent to 83 percent of people with SLE, anti-double-stranded DNA (anti-dsDNA) antibodies are often found at high levels in people with active SLE. High anti-dsDNA levels can signal active SLE and even predict flares.
The levels of anti-dsDNA antibodies can change drastically over time, depending on lupus disease activity and treatment. Anti-dsDNA antibody levels can rise during a flare and almost disappear during treatment.
Anti-Smith (anti-Sm) antibodies are found in 5 percent to 30 percent of those with SLE. They are found mainly in people with SLE, so finding them can help confirm the diagnosis.
Anti-U1 ribonucleoprotein (anti-RNP) antibodies are often found in people with mixed connective tissue disease (MCTD), a disease with a combination of symptoms of SLE, rheumatoid arthritis, and scleroderma. So, anti-RNP antibodies and ANAs aren’t enough on their own to confirm a lupus diagnosis.
Anti-Ro antibodies are found in 25 percent to 30 percent of people with SLE. Anti-La antibodies are found in 7 percent to 45 percent of people with SLE, depending on the population studied and the type of test used. They are also found in those with other autoimmune disorders, including Sjögren’s disease, subacute cutaneous lupus erythematosus, and neonatal lupus erythematosus, affecting babies born to a parent with lupus.
ANA levels may change with disease activity, but they cannot be relied on to determine the level of disease activity. There’s no definite connection between ANA levels and disease activity, and repeating the measurements isn’t that useful.
Understanding your ANA results can be confusing — and you don’t have to interpret them alone. Talk with your rheumatologist or healthcare provider about what your test results mean in the context of your symptoms, history, and treatment plan.
While ANA patterns and levels can provide helpful clues, they’re just one part of the puzzle. You and your doctor can work together to understand the bigger picture and make informed decisions about your lupus care.
On MyLupusTeam, people share their experiences with lupus, get advice, and find support from others who understand.
How have your ANA patterns changed over time? Let others know in the comments below.
Get updates directly to your inbox.
I Asked About Getting A PDF Copy Of This. Now I'm Looking At The References And None Of Them Are Dated???
Continue with Facebook
Sign up with your email
Become a member to get even more
Join
A MyLupusTeam Member
Most doctors don't use this information. Every time my ANA looks fine I am told my lupus is inactive and I am swelling and in pain and nothing is being done.
We'd love to hear from you! Please share your name and email to post and read comments.
You'll also get the latest articles directly to your inbox.