Can steroids, such as prednisone (corticosteroid), affect double-strand Anti-Nuclear Antibody (ANA) test results in patients with a history of autoimmune disease?

Can Steroids Affect Double-Strand DNA (dsDNA) Antibody Test Results?

Corticosteroids do not directly interfere with the laboratory measurement of anti-dsDNA antibodies, but they can suppress disease activity in autoimmune conditions like SLE, which may indirectly lead to decreased anti-dsDNA antibody levels over time through disease modification rather than test interference.

Understanding the Relationship Between Steroids and Anti-dsDNA Testing

Direct Laboratory Interference

• There is no evidence that corticosteroids cause direct laboratory interference with anti-dsDNA antibody assays, whether measured by Crithidia luciliae immunofluorescence test (CLIFT) or solid phase assays like ELISA 1.
• The testing methodology itself remains unaffected by the presence of corticosteroids in patient serum 1.

Indirect Effects Through Disease Modification

• Anti-dsDNA antibody levels can fluctuate widely during the natural course of disease and in response to therapy, unlike anti-RBP antibodies which tend to remain stable 2.
• Evidence from clinical trials demonstrates that ANA responses can decrease over time due to the effects of immunosuppressive therapy, including corticosteroids 2.
• Many patients with established SLE who previously tested ANA-positive can become ANA-negative during follow-up, suggesting that treatment effects can modify autoantibody expression 2.

Clinical Implications for Testing Strategy

When to test anti-dsDNA in patients on corticosteroids:

• For initial diagnosis, anti-dsDNA testing should be performed using a double-screening strategy with solid phase assay first, followed by CLIFT confirmation, regardless of corticosteroid use 3.
• For monitoring established SLE, quantitative anti-dsDNA assays should be performed using the same method consistently by the same laboratory to track true changes in disease activity 3, 4.
• Anti-dsDNA levels that reflect disease activity may decrease with effective corticosteroid therapy, but this represents therapeutic response rather than test interference 2.

Important Caveats

Do not confuse test interference with therapeutic effect:

• A decrease in anti-dsDNA levels during corticosteroid therapy likely indicates disease suppression and treatment response, not laboratory artifact 2.
• Corticosteroid therapy in autoimmune hepatitis patients with positive anti-dsDNA by ELISA has been associated with treatment failure in some cases, suggesting the antibodies themselves may predict steroid responsiveness rather than being affected by steroids 5.

Avoid these common pitfalls:

• Do not attribute declining anti-dsDNA levels solely to "steroid interference" when they may represent actual disease improvement 2.
• Do not switch testing methods during monitoring, as different platforms (CLIFT vs. ELISA) have fundamentally different test characteristics and can yield discrepant results independent of steroid effects 3, 4.
• Remember that ANA testing should not be repeated for monitoring once diagnosis is established; instead, use quantitative anti-dsDNA and complement levels 3, 4.

Practical Testing Algorithm

For patients on corticosteroids requiring anti-dsDNA testing:

1. Initial diagnostic testing: Proceed with standard double-screening approach (solid phase assay followed by CLIFT confirmation) without concern for steroid interference 3.

2. Monitoring established disease: Use the same quantitative method consistently, recognizing that decreasing levels may reflect therapeutic response 3, 2.

3. Interpreting results: Consider declining anti-dsDNA levels in the context of clinical improvement and complement normalization as evidence of treatment efficacy rather than test artifact 3.