Antinuclear Antibody Titer, Elevated

Antinuclear Antibody Titer, Elevated: Excerpt from The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter

Judith A. Fisher and Douglas J. Ivins

In the practice of cost-effective medicine, no value is seen to routine laboratory testing. An antinuclear antibody titer (ANA) should only be ordered in cases of a clinical suspicion of a rheumatologic disease (also known as connective tissue disorder) (1–2).

Approach

The patient may present with vague complaints of malaise, aches, or skin rash. On the other hand, the complaint may be of a red, hot, or swollen joint or joints. If a rheumatologic disease is suspected, an ANA can be ordered. It is important to remember that the specificity of a positive ANA titer for all rheumatic diseases is only 50% (3). With that in mind, ANA titers of more than 1/160 may be significant (1). The characteristic staining patterns associated with ANAs can be helpful. Homogeneous (diffuse) and speckled patterns are relatively nonspecific.

Peripheral patterns are often seen in systemic lupus erythematosus. Nucleolar patterns are more typical for scleroderma. A mildly elevated ANA and no disease process (falsely positive ANA) is found in 5% of young adults and in 18% of individuals aged more than 65 years (1).

The history and physical examination will help to place the patient into one of several diagnostic categories (Table 17.3).

It is important to remember to order an ANA only with a clinical suspicion of a disease process in which the ANA value plays a significant role.

References

1. Jacobs D. Laboratory test handbook, 3rd ed. Hudson, OH: Lexi-Comp, Inc., 1994:
638–640.

2. Nakamura R. Clinical diagnosis and management by laboratory methods, 4th ed. Philadelphia: WB Saunders, 1996:1013–1023.

3. Wallach J. Interpretation of diagnostic tests, 6th ed. Boston: Little, Brown, and Company, 1996:817–820.

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Book Source Details

• Book Title: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter
• Author(s): Robert B. Taylor (editor)
• Year of Publication: 2000
• Copyright Details: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, Copyright © 2000 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter Authors: Robert B. Taylor (editor) Publisher: Lippincott Williams & Wilkins Copyright: 2000 ISBN: 0-78172-094-X

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