Antinuclear Antibody (ANA) Testing

1. David M. Siegel, MD, MPH 1. University of Rochester School of Medicine and Dentistry, Rochester, New York 1. The Outcome of Children Referred to a Pediatric Rheumatology Clinic With a Positive Antinuclear Antibody Test but Without an Autoimmune Disease. Deane PMG, Liard G, Siegel DM, Baum J Pediatrics.1995;95 :892– 895 [OpenUrl][1][Abstract/FREE Full Text][2] 2. Persistent Antinuclear Antibodies in Children Without Identifiable Inflammatory Rheumatic or Autoimmune Disease. Cabral DA, Petty RE, Fung M, Malleson PN. Pediatrics.1992;89 :441– 444 [OpenUrl][3][Abstract/FREE Full Text][4] 3. Usefulness of Antinuclear Antibody Testing to Screen for Rheumatic Diseases. Malleson PN, Sailer M, Mackinnon MJ. Arch Dis Child.1997;77 :299– 304 [OpenUrl][5][Abstract/FREE Full Text][6] 4. Antinuclear Antibodies. Peng SK, Craft J. In: Ruddy S, Harris ED, Sledge CB, eds. Kelley’s Textbook of Rheumatology. 6th ed. Philadelphia, Pa: WB Saunders Co; 2001:161–172 Testing for the presence of antinuclear antibody (ANA) should be undertaken in a patient for whom relevant connective tissue or rheumatologic disorders are credible diagnostic considerations. It can serve as a laboratory marker that supports confirmation of a disease already suspected based on the child’s history and physical examination (such as in systemic lupus erythematosus [SLE]) or to subcategorize a condition at risk for complications (such as the presence of ANA in the setting of oligoarticular juvenile arthritis). In the case of the former, further assay for antibody specificity is necessary to determine which nuclear autoantigens are targeted, leading to greater accuracy in determining whether SLE or some other autoimmune disorder is present. Because ANA can be present in children and adolescents who are without disease, the test can be misleading if used for screening in the absence of a consistent clinical picture. An ANA-related phenomenon initially was reported in 1948 by Hargraves and was labeled the “LE” cell. The authors described obtaining concentrated bone marrow specimens from patients who had SLE and demonstrating the phagocytosis of antibody-sensitized nuclei by polymorphonuclear leukocytes. The cause of the LE cell mechanism was found later to be due to plasma autoantibody directed against deoxyribonucleoprotein. Although still occasionally available as a laboratory assay, the LE cell test has given way to the indirect immunofluorescence ANA test (FANA), which is a much more sensitive technique for … [1]: {openurl}?query=rft.jtitle%253DPediatrics%26rft.stitle%253DPediatrics%26rft.issn%253D0031-4005%26rft.aulast%253DDeane%26rft.auinit1%253DP.%2BM.%2BG.%26rft.volume%253D95%26rft.issue%253D6%26rft.spage%253D892%26rft.epage%253D895%26rft.atitle%253DThe%2BOutcome%2Bof%2BChildren%2BReferred%2Bto%2Ba%2BPediatric%2BRheumatology%2BClinic%2BWith%2Ba%2BPositive%2BAntinuclear%2BAntibody%2BTest%2Bbut%2BWithout%2Ban%2BAutoimmune%2BDisease%26rft_id%253Dinfo%253Apmid%252F7761217%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=95/6/892&atom=%2Fpedsinreview%2F24%2F9%2F320.atom [3]: {openurl}?query=rft.jtitle%253DPediatrics%26rft.stitle%253DPediatrics%26rft.issn%253D0031-4005%26rft.aulast%253DCabral%26rft.auinit1%253DD.%2BA.%26rft.volume%253D89%26rft.issue%253D3%26rft.spage%253D441%26rft.epage%253D444%26rft.atitle%253DPersistent%2BAntinuclear%2BAntibodies%2Bin%2BChildren%2BWithout%2BIdentifiable%2BInflammatory%2BRheumatic%2Bor%2BAutoimmune%2BDisease%26rft_id%253Dinfo%253Apmid%252F1741219%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=89/3/441&atom=%2Fpedsinreview%2F24%2F9%2F320.atom [5]: {openurl}?query=rft.jtitle%253DArchives%2Bof%2BDisease%2Bin%2BChildhood%26rft.stitle%253DArch.%2BDis.%2BChild.%26rft.issn%253D0003-9888%26rft.aulast%253DMalleson%26rft.auinit1%253DP.%2BN%26rft.volume%253D77%26rft.issue%253D4%26rft.spage%253D299%26rft.epage%253D304%26rft.atitle%253DUsefulness%2Bof%2Bantinuclear%2Bantibody%2Btesting%2Bto%2Bscreen%2Bfor%2Brheumatic%2Bdiseases%26rft_id%253Dinfo%253Apmid%252F9389231%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [6]: /lookup/ijlink?linkType=ABST&journalCode=archdischild&resid=77/4/299&atom=%2Fpedsinreview%2F24%2F9%2F320.atom