Positive ANA Test Results? - Clearing up autoimmune screening test confusion
Many people who seek out Rheumatology care have a positive ANA. It’s a test that causes a lot of anxiety! The first thing people seem to hear if they have a +ANA is “you may have Lupus.” But many times, that’s not even close to true. So, let’s talk about what a positive ANA means–and equally importantly, what it doesn’t mean!
The ANA test is a blood test looking for the presence of Anti-Nuclear Antibodies, which is an auto-antibody. An antibody is simply a protein made by our immune system to fight off infections. Our immune system is constantly making antibodies targeting bacteria and viruses. But it also makes many that target our own tissues (these are “auto-antibodies”). Typically, a healthy immune system is able to identify these auto-antibodies and destroy them so they don’t wreak havoc. Unfortunately, sometimes auto-antibodies are allowed to flourish and this can lead to autoimmune disease.
The ANA test is considered an autoimmune “screening” test and there are many reasons why someone may have the test done. Often, vague symptoms such as fatigue, joint pain, rashes, or hair loss can lead a doctor to test for the ANA. Whatever the reason, if it returns positive, you will most likely be advised to see a rheumatologist. In the meantime, many of us will consult Dr. Internet and allow our imaginations and anxieties to get the better of us.
So, let’s clear this up with some plain language:
The ANA does NOT cause autoimmune conditions. A positive ANA has been associated with autoimmune conditions. But this does not mean it causes autoimmune conditions. In fact…
Many people with a +ANA blood test have NO CONDITION AT ALL! That’s it–just nothing.
The ANA is just a test, it’s NOT a diagnosis. Because a +ANA has been associated with autoimmune conditions, it warrants further investigation. This includes testing more specific autoantibodies to better understand what, if anything, is going on.
ANA is notoriously non-specific. It is NOT more strongly associated with Lupus (or SLE, Systemic Lupus Erythematosus) than any other autoimmune condition. Some other conditions it may be associated with are Sjogren’s Syndrome, Rheumatoid Arthritis, Scleroderma, viral infections and even some cancers. But before you begin to worry, remember what we said: Many with a +ANA blood test have NO CONDITION AT ALL!
In most cases, how “high” or “low” your ANA is doesn’t matter as much as you may think.
Let’s unpack this last point. The ANA result is not simply reported as “positive” or “negative,” but as a “titer.” A titer is seen on reports as a ratio, for example 1:40, 1:160 or 1:5600. What do these mean?
If your result is on the extremes, either very low or very high, your doctor will likely draw certain conclusions. For example, if your ANA test is very low (1:40 or 1:80) it is most likely considered a false positive until proven otherwise. If your ANA is very high (let’s say above 1:28,000) it will get more attention by the Rheumatologist.
But most people will have an ANA somewhere in the middle and the exact ratio doesn’t tell us much. Instead, what’s most important is to have a thorough physical exam, an in-depth conversation about your symptoms, medical history and lifestyle history, and to gather information from other tests. No blood test in Rheumatology is interpreted in isolation. Everything must be put into the context of the individual.
For many people, further investigating a Positive ANA with a Rheumatologist will lead to relief–they have no condition at all! That leads to two common and reasonable questions:
Am I at higher risk with a +ANA?
When should I have it checked again?
How we determine someone’s risk for an autoimmune disease is more art than science at this point. We consider family history, a person’s symptoms, and all test results when determining if an individual is “high risk.” The ANA result alone can’t guide this determination. Frequently, repeating a non-specific lab test like the ANA can lead to more confusion and anxiety than it’s worth. So, when is it useful? It’s worth repeating if someone’s symptoms have changed, for example, if someone develops joint pain, fatigue, hair loss or worsening rashes. Repeating the ANA simply for the sake of repeating it can lead to unnecessary testing and worry.
One of the things that is most difficult about getting a + ANA is the worry and uncertainty. This is made a lot worse by typically very long wait times to see a rheumatologist. Often it’s months before you get in for a first visit! That’s why at Motto, we make appointments available within weeks. We also provide two, in-depth, 1-hour appointments so we can provide ample time and attention you need to provide us a thorough history and get all your questions answered.
Our program is designed to give you clarity and a path forward the first time around so you can feel confident in making your next move.