Understanding Your Positive ANA Test
A positive ANA test in the setting of fatigue and chronic joint pain does not automatically mean you have an autoimmune disease—in fact, over 90% of patients referred for a positive ANA have no autoimmune condition identified. 1
What Does Your Positive ANA Mean?
Positive ANA tests are common in healthy people: Up to 32% of healthy individuals can have a positive ANA at low titers (1:40), 13% at 1:80, and 5% at 1:160. 2
The titer matters significantly: If your ANA titer is below 1:160, the likelihood of having an autoimmune disease is very low, and no autoimmune disease was identified in patients with titers below this level in clinical studies. 1, 2
The pattern on your test is important: A speckled pattern (which is common) suggests antibodies to specific proteins like SSA/Ro, SSB/La, or RNP, and helps guide what additional testing might be needed. 2
Why Your Doctor Ordered This Test
Fatigue and joint pain are very common reasons for ANA testing (accounting for 23% of ANA orders), but these symptoms alone have low predictive value for autoimmune disease. 1
Many conditions can cause a positive ANA including chronic infections, vitamin D deficiency, certain medications, and normal aging—especially in women. 3, 4
What Happens Next
Your doctor will likely order additional blood tests to look for more specific antibodies that would confirm or rule out autoimmune diseases:
If your titer is ≥1:160: Testing for specific antibodies (anti-dsDNA, anti-Sm, anti-RNP, anti-SSA/Ro, anti-SSB/La) should be performed, as this titer has much better specificity for autoimmune disease. 2
If your titer is <1:160: Your doctor should exercise caution in interpretation, as this has a low positive likelihood ratio for disease. 2
Additional basic tests may include a complete blood count, kidney and liver function tests, and urinalysis to look for signs of organ involvement. 2
Important Points to Remember
A positive ANA alone is NOT a diagnosis—it must be interpreted alongside your symptoms, physical examination findings, and other laboratory results. 2, 5
Most people with positive ANA tests do not develop autoimmune disease: The positive predictive value for lupus specifically is only 2.1%, and for any autoimmune disease is 9.1% in patients referred to specialists. 1
ANA testing should not be repeated once done—it is a diagnostic test, not a monitoring test, and repeating it does not provide useful information. 2
If you have no other concerning symptoms or laboratory abnormalities, your positive ANA may simply reflect normal immune system variation and may not require any treatment or further extensive workup. 6, 3
When to Be More Concerned
Seek prompt follow-up if you develop:
- Unexplained rashes, especially on sun-exposed areas 5
- Significant unexplained weight loss 5
- Blood in your urine or significant swelling 2
- Severe mouth ulcers 5
- New neurological symptoms 5
- Chest pain with breathing 5
The key message: A positive ANA test requires clinical correlation with your symptoms and additional testing, but by itself does not mean you have a serious autoimmune disease. Your doctor will guide you through appropriate next steps based on your specific situation and test results. 2, 1