Note on Antinuclear Antibodies (ANA)

DESCRIPTION

The immune system makes an abundance of proteins called antibodies. Antibodies are made by white blood cells and they recognize and combat infectious organisms in the body. Sometimes these antibodies make a mistake, identifying normal, naturally-occurring proteins in our bodies as being “foreign” and dangerous. The antibodies that target “normal” proteins within the nucleus of a cell are called antinuclear antibodies (ANA). ANAs could signal the body to begin attacking itself which can lead to autoimmune diseases, including lupus, scleroderma, Sjögren’s syndrome, polymyositis/ dermatomyositis, mixed connective tissue disease, drug-induced lupus, and autoimmune hepatitis. A positive ANA can also be seen in juvenile arthritis.

FAST FACTS

A positive ANA test means autoantibodies are present.

By itself, a positive ANA test does not indicate the presence of an autoimmune disease or the need for therapy.

Autoimmune diseases can be treated.

WHAT IS AN ANTIBODY OR ANA?

Antibodies develop in our immune system to help the body fight infectious organisms. When an antibody recognizes the foreign proteins of an infectious organism, it recruits other proteins and cells to fight off the infection. This cascade of attack is called inflammation.

Unfortunately, some antibodies make incorrect calls, identifying a naturally-occurring protein (or self protein) as foreign. These autoantibodies start the cascade of inflammation, causing the body to attack itself.

Most of us have autoantibodies, but typically in small amounts. The presence of large amount of autoantibodies or ANAs can indicate an autoimmune disease.

HOW DO YOU TEST FOR ANTINUCLEAR ANITBODIES?

There are several methods used to test for ANAs. One method is a blood test called the Fluorescent Antinuclear Antibody Test or FANA. This test involves viewing fluorescent-labeled antibodies on a glass side under the microscope and determining the pattern and intensity of the fluorescence.

The sensitivity and simplicity of an ANA test makes it extremely popular to screen for lupus in particular. Since most people (more than 95% of individuals) with lupus will test positive, a negative ANA test can be helpful in excluding that diagnosis. That said, only about 11-13% of persons with a positive ANA test have lupus and up to 15% of completely healthy people have a positive ANA test. Thus a positive ANA test does not automatically translate into a diagnosis of lupus or any autoimmune or connective tissue disease.

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Antinuclear antibodies (photomicrographs)

In clockwise order, the peripheral, diffuse, nucleolar and speckled immunofluorescent patterns are presented.

HOW ARE FANA LEVELS MEASURED?

ANA test results are reported in titers and the patterns that the autoantibodies make, e.g., homogeneous, speckled, centromere, etc. This titer reading is determined by adding saline (salt water) to the liquid portion of a person’s blood.

For example, 1 part blood is mixed with 40 parts saline to create a 1:40 dilution. The dilution then is taken through a series of additional steps, creating tubes of 1:80, 1:160, 1:320, and 1:640 dilutions, respectively.

Labs vary in their standards for “positive,” e.g., some labs will report any titer above 1:160 as positive. Your physician will interpret the ANA results based on the clinical history.

WHAT DOES A POSITIVE ANA READING MEAN?

A negative ANA reading means no autoantibodies are present in the body. However, a positive ANA reading alone does not indicate an autoimmune disease. Why?

The prevalence of ANAs in healthy individuals is about 3-15%. The production of these autoantibodies is strongly age-dependent, and increases to 10-37% in healthy persons over the age of 65. Even healthy people with viral infections can have a positive ANA, albeit for a short time.

Some medications can cause a positive ANA. It is important to talk with your doctor all the drugs you are taking—prescription, over-the-counter and street.

Other conditions, such as cancer, can cause a positive ANA.

The positive ANA reading simply tells your doctor to keep looking. In fact, you may have a “false positive” ANA, which means that the evidence is not there to make a diagnosis of lupus or any other autoimmune disease. To make a definite diagnosis, your doctor will need more blood tests along with history of your symptoms and a physical examination.

HOW SHOULD I HANDLE A POSITIVE ANA READING?

Please note a positive ANA does not require immediate treatment. Remember, lab levels vary, some autoantibodies are normal and this may be a false positive result. Your doctor will determine what happens next based on additional exploration. By working with your doctor and asking questions you will get the best care for your particular situation.

Keep in mind, even if your ANA reading does lead to an autoimmune diagnosis, there are treatments for autoimmune diseases.