Steroids Do Not Cause False Positive ANA Tests
No, taking corticosteroids for cervical neuralgia does not cause a false positive ANA (antinuclear antibody) test. In fact, steroids have immunosuppressive effects that would theoretically reduce autoantibody production rather than increase it.
Why This Question Arises in Clinical Practice
The confusion likely stems from the fact that steroids are used to treat both cervical neuralgia and autoimmune conditions where ANA is positive. However, the relationship is correlative, not causative:
- Steroids are used to treat autoimmune conditions where ANA may already be positive, but they do not cause the positive ANA 1
- Cervical radiculopathy responds well to oral corticosteroids (prednisolone 50 mg/day tapered over 10 days shows significant pain reduction), but this treatment does not interfere with ANA testing 2
What Actually Causes False Positive ANA Results
The evidence shows that certain medications and conditions can cause false positive ANA, but corticosteroids are not among them:
- Medications that can cause drug-induced lupus and positive ANA include hydralazine, procainamide, isoniazid, and certain anti-TNF biologics—but not corticosteroids 1
- Technical factors such as cross-reactivity in immunoassays can affect cortisol measurements, but ANA testing uses different methodology 1, 3
Clinical Context: When ANA and Steroids Intersect
In clinical practice, you may encounter patients on steroids who have positive ANA in these scenarios:
- Underlying autoimmune disease: A patient with cervical neuralgia may have an undiagnosed autoimmune condition (like SLE) that is causing both the neurological symptoms and the positive ANA 4, 5
- Steroid-responsive autoimmune neuropathy: Multiple cranial neuropathy with positive ANA responds to steroids, but the steroids treat the condition—they don't cause the positive ANA 5
- Monitoring during immunotherapy: When checking ANA as part of a hepatitis workup during immune checkpoint inhibitor therapy, steroids are used as treatment for the hepatitis, not as a cause of positive autoantibodies 1
Important Pitfalls to Avoid
- Do not attribute a positive ANA to steroid use—investigate for underlying autoimmune disease 4, 5
- Do not delay appropriate autoimmune workup in a patient on steroids who has a positive ANA, as this may represent undiagnosed systemic lupus erythematosus or other connective tissue disease 4
- Remember that steroid treatment can mask symptoms of autoimmune disease while the ANA remains positive, so a positive ANA in a patient on steroids warrants further investigation even if symptoms are controlled 5
What to Do If Your Patient Has Both
If your patient on steroids for cervical neuralgia has a positive ANA:
- Complete the autoimmune workup: Check anti-dsDNA, complement levels (C3, C4), anti-Smith antibodies, and other specific autoantibodies based on clinical presentation 1, 4
- Assess for systemic symptoms: Look for rash, arthritis, serositis, renal involvement, or other features of systemic autoimmune disease 4
- Consider that the cervical symptoms may be part of an autoimmune syndrome rather than isolated mechanical pathology 4, 5
- Note that ANA titer may remain elevated despite steroid treatment if there is underlying autoimmune disease, as steroids treat inflammation but don't necessarily normalize autoantibody levels 5