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ANA tests identify autoantibodies in the body. And, they are one of the tools that clinicians use to help diagnose lupus.

Rheumatologists review laboratory tests, symptom logs, and family history before making a lupus diagnosis. This can be a long and challenging process. ANA tests are a crucial element as they offer insight into the functioning of the immune system by measuring the presence of particular proteins in the blood.

The newest criteria for determining a lupus diagnosis was established by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) in 2018. The first requirement of the criteria to be diagnosed is:

  • Positive ANA test with a titer of at least 80

The titer value relates to the ratio of blood serum being tested to a dilution agent. So, a titer of 80 would mean that for every 80 parts of dilution, there was one part of blood serum. The higher the dilution, the more antibodies would need to be in the blood sample to return a positive result for the test.

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What are Antinuclear Antibodies (ANA)?

Before jumping to antinuclear antibodies, we will start with antibodies. Antibodies are proteins made by your immune system that help your body recognize and fight harmful substances, such as bacteria and viruses, by activating the immune system to target them. You can think of antibodies as the soldiers that protect your body from bad, foreign invaders.

Sometimes, antibodies mistakenly attack healthy cells and tissues in the body. This is known as an autoimmune response. Antibodies that target healthy proteins specifically in the nucleus of your cells are called antinuclear antibodies (ANA). To continue the analogy from above, ANAs are rogue soldiers that misidentify the cells they are supposed to ignore, and attack them in error.


NOTE: Most people have some ANA, but having too many of these proteins puts you at an increased risk for developing an autoimmune disease, such as lupus.

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Who Gets ANA Tests?

Typically, an ANA test is ordered when someone has symptoms that may indicate a systemic autoimmune disease. Some examples of symptoms that may prompt a doctor to order the test include (but are not limited to):

  • low-grade fevers
  • arthritis-like pain
  • fatigue
  • weakness
  • headaches
  • rashes
  • muscle pain

Even with a positive ANA test result, it is not clear that a person has lupus. A study published in 2003 in the New England Journal of Medicine found that 88% of people (115 out of 130) eventually diagnosed with lupus had received a positive autoantibody lab result multiple years prior to the diagnosis. On average, that positive test result occurred 3.3 years before the diagnosis was confirmed.

Quick Stats on ANA Tests and Lupus

  • 97% of people with lupus will have a positive ANA test.
  • Between 5-20% of the general population will have a positive ANA test. A positive test can be a false-positive, or indicate other conditions, such as thyroid disease, certain liver conditions, or other autoimmune diseases.
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What Should I Know About ANA Tests and Lupus?

  • There is no one definitive test for lupus – an ANA test is just one tool used to help diagnose lupus.
  • The ANA test is not a specific test for lupus. This means that most people with lupus will have a positive ANA test, but not everyone with a positive ANA test has lupus.
  • Some medications can produce a positive ANA test, so be sure to tell your doctor about any prescription or over-the-counter drugs you take.
  • Test results can fluctuate over time and when they are performed at different labs. However, if you have active lupus, your ANA test will probably be positive at most labs, most of the time.

How is an ANA Test Performed?

  • An ANA test is performed in a laboratory, using a sample of your blood.
  • The test shows if your immune system is producing antinuclear antibodies. A positive ANA test means antinuclear antibodies are present.
  • The most common strategies used for detecting and measuring ANAs are indirect immunofluorescence and enzyme-linked immunosorbent assay (ELISA).
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What Should I Do if My ANA Test is Positive?

  • Your doctor will interpret your ANA test in the context of your symptoms, other lab work, and your medical history, including family history. Keeping a symptom journal or using digital tools can help you be better prepared to go over your symptoms with your doctor.
  • Remember, a single positive ANA does not mean you have an autoimmune disease. And a positive ANA test does not require immediate treatment. Your lupus treatment team will take the ANA test results in context with many other factors.
Comments (8)

8 thoughts on “ANA Tests and Lupus

    1. You need the AVISE panel. John’s Hopkins also says the those with a negative ANA all have a positive Anti-SSA/Ro.

  1. I was diagnosed with SLE thirty-five years ago at age thirty, although I had been symptomatic since age twelve. My lupus prep test came out positive. I then went to a rheumatologist and my ANA was negative but the double stranded anti-DNA test was positive. It remains positive to this day and recently I have been diagnosed with Lupus nephritis stage three. Anyone here have a similar experience? I have never had a positive ANA test result. Dietary and treatment suggestions other than steroids please. I have a psychotic reaction to steroids.

  2. My ANA titter is 2560 (yes 2560). Chronic low RBC. High ESR. Severe joint inflammation. Last 3 years hematuria and Proteinuria (both unexplained and kidney infection without micro growth). Skin lesions. Hair loss. Fluid retention. Extreme fatigue. Among a list of other symptoms and flagged results worsening over last 3 years. First symptom 20 years ago (butterfly rash with photosensitive hives rash’s). And the Rheumatologist DX -Undifferentiated mixed tissue disease because she didn’t want to label me with Lupus yet! Why is it so difficult to get straight answers? Plaquenil helped at 3-4 months and now I’m getting worse again

  3. I have had my ANA tested 3 times. 2 times it was 1:160 and 1 time negative. My double stranded anti-DNA is negative but my c4 was a 13 and ch50 a 33 . I have also tested positive for cardiolipin antibodies when he did blood work to ID it my IGM AB was at a 56.2 My sed rate has always been low at a 8.
    I have no idea still what is going on with me, I’ve had severe fatigue along with joint and muscle pain for over 10 years I have tachycardia involvement with my heart that the cardiologist doesn’t know why. Multiple constant UTIs that lead into kidney infections in the blink of an eye I do have the butterfly rash it seems to show more on my face the worse I feel. I’m just lost and confused I’m so tired of not knowing what’s going on with me

  4. i have a postive ANA 1:80 and negative in all the subtypes. I have other high inflammation markers that fluctuate alot like my CRP an HS-CRP, elevated D-dimer that fluctates, high CK that fluctuates, fatigue, joint pain, osteoarthritis that is creating bone spurs in many joints, headaches, random 99 fevers, red rashes in the sun especially on thighs. no one can figure out why my inflammation levels do this, i do not have a Lupus diagnosis…no one knows whats the issue..im 38. i wish i knew

  5. CRP 9.7
    ANA Ab screen POSITIVE
    ANA Titer <1:40 ANA pattern none detected
    DNA (ds) Ab, Crithidia IFA POSITIVE
    DNA (AB) (DS) Crithidia Titer 1:40, Titer H (<1:10)
    Rheumatoid factor 14
    SM Antibody negative
    SM/RNP Antibody negative
    Sjogren’s Antibody SS-A 4.1 POSITIVE
    Sjogren’s Antibody SS-B negative
    SCL negative
    I know I definitely will be diagnosed with Sjogren’s, my mouth is dry and peeling with inflamed gums.(can lupus cause the same mouth symptoms?). I have noticed last year when I was in the sun a lot I had an uncontrolled itchy rash on my arms. Can high platelets also indicate lupus? I appreciate any feedback on my current blood work. Do you think I might have lupus?
    Thank you!

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