What is the next step after a positive speckled Antinuclear Antibody (ANA) test?

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Last updated: February 17, 2025 • View editorial policy

From the Guidelines

Following a positive speckled antinuclear antibody (ANA) test, the next step is to perform confirmatory testing of anti-extractable nuclear antigen (ENA) autoantibodies to help guide diagnosis and management 1, 2. This may involve ordering additional laboratory tests, such as:

  • Anti-Sm
  • Anti-RNP
  • Anti-SSA
  • Anti-SSB to determine the underlying cause of the positive ANA result 1. When ordering these tests, it is essential to include pertinent clinical information so the laboratory can assess the results and decide on subsequent studies 2. If systemic lupus erythematosus (SLE) or mixed connective tissue disease is suspected, treatment with hydroxychloroquine (200-400 mg daily) or prednisone (5-10 mg daily) may be initiated, with close monitoring of clinical response and laboratory parameters. It is crucial to follow standard testing protocols based on the EULAR/ACR 2019 criteria and to use a 1:160 dilution as the cut-off point for ANA detection in unselected populations 2.

From the Research

Next Steps After a Positive Speckled Antinuclear Antibody (ANA) Test

  • A positive speckled ANA test result may indicate the presence of an autoimmune disorder, such as systemic lupus erythematosus (SLE) or mixed connective tissue disease (MCTD) 3, 4.
  • The next step would be to perform additional tests to confirm the diagnosis, such as: + Extractable nuclear antigen (ENA) antibodies, including anti-Ro/SS-A, anti-La/SS-B, and anti-RNP 5. + Anti-double-stranded DNA (anti-dsDNA) antibodies 5, 6. + Other laboratory tests, such as complete blood count, erythrocyte sedimentation rate, and C-reactive protein 7.
  • A physical examination and medical history should also be taken to assess for any symptoms or signs of an autoimmune disorder 7.
  • The patient may be referred to a rheumatologist for further evaluation and management 7.
  • It is essential to note that a positive ANA test result does not necessarily mean that the patient has an autoimmune disorder, as the test can be positive in healthy individuals or those with other conditions 7.
  • The clinical utility of a positive ANA test result shouldn't be overestimated, as it has a low positive predictive value for autoimmune disorders, especially in patients with low pretest probabilities 7.
  • Longitudinal follow-up of patients with recent-onset SLE has shown that some patients may lose ANA-positivity over time, while others may switch staining patterns 6.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.