Antibodies are proteins made by your immune system. They help your body recognize and fight infections. Antibodies normally target harmful substances, such as bacteria and viruses, by activating the immune system to get rid of them.
Sometimes, however, antibodies mistakenly target your healthy cells and tissues. This is known as an autoimmune response. Antibodies that attack healthy proteins within the nucleus — the control center of your cells — are called antinuclear antibodies (ANA).
When the body receives signals to attack itself, autoimmune diseases such as lupus, scleroderma, mixed connective tissue disease, autoimmune hepatitis, and others can occur. Symptoms vary by disease, but they may include rashes, swelling, arthritis, or fatigue.
While it’s normal to have some ANA, having too many of these proteins is a sign that there may be an active autoimmune disease, such as lupus. An ANA panel helps determine the level of ANA in your blood. You may have an autoimmune disorder if the level is high. However, conditions such as infections, cancer, and other medical problems can also result in a positive ANA test.
Your doctor will often order an ANA panel if you have signs or symptoms of an autoimmune disorder. An ANA test may indicate that you have some type of autoimmune condition, but it can’t be used to diagnose a specific disorder. If your test comes back positive, your doctor will need to do more specific and detailed testing to determine if an autoimmune disease is causing your symptoms.
There is no preparation needed for the ANA panel. However, it’s important to tell your doctor about any medications or supplements that you’re taking, even over-the-counter ones. Some drugs, such as certain seizure and heart medications, can affect the accuracy of the test.
The ANA panel is similar to other blood tests. A phlebotomist will tie an elastic band around your upper arm so your veins swell with blood. This makes it easier for them to find a vein. After cleaning the site with an antiseptic, they’ll insert a needle into a vein. You might feel some moderate pain when the needle goes in, but the test itself isn’t painful. Blood is then collected in a tube attached to the needle. Once the blood is collected, the phlebotomist will remove the needle from your vein and cover the puncture site.
In infants or children, a lancet (small scalpel) may be used to puncture the skin, and blood may be collected in a small tube called a pipette. It may also be collected on a test strip.
The blood is then sent to a lab for examination.
The risks of doing an ANA panel are minimal. People with veins that are harder to access may experience more discomfort than others during the blood test. Other risks can include:
- excessive bleeding
- infection at the puncture site
- hematoma (blood building up under the skin)
A negative test means that certain autoimmune diseases are less likely. However, other tests may still be needed based on your symptoms. Some people with autoimmune diseases may test negative for ANA but positive for other antibodies.
A positive ANA test means that you have high levels of ANA in your blood. A positive ANA test is usually reported as both a ratio (called a titer) and a pattern, such as smooth or speckled. Certain diseases are more likely to have certain patterns. The higher the titer the more likely the result is a “true positive” result, meaning you have significant antinuclear antibodies and an autoimmune disease.
However, a positive result doesn’t always mean that you have an autoimmune disease. Up to 15 percent of completely healthy people have a positive ANA test. This is called a “false-positive” test result. ANA titers can also increase with age among healthy people, so it’s important to talk to your doctor about your symptoms and what your result means to you.
If your primary doctor ordered the test, they may recommend a referral to a rheumatologist — an autoimmune disease specialist — to follow up any abnormal ANA results. They can often help determine if your test results are related to a specific condition.
A positive ANA test alone can’t diagnose a specific disease. However, some conditions that are associated with a positive ANA test include:
- systemic lupus erythematosus (lupus): an autoimmune disorder that can affect different parts of your body, including the heart, kidneys, joints, and skin
- autoimmune hepatitis: an autoimmune disorder that causes inflammation of the liver, along with rashes, joint pain, fatigue, poor appetite, and nausea
- rheumatoid arthritis: an autoimmune disorder that causes joint destruction, pain, swelling, and stiffness in the joints and affects the lungs, heart, eyes and other organs
- Sjögren syndrome: an autoimmune disorder that affects the salivary and lacrimal glands, which produce saliva and tears
- scleroderma: an autoimmune disorder that primarily affects the skin and other connective tissues but can affect organs as well
- autoimmune thyroid disease: a range of conditions that affect your thyroid, including hypothyroidism and hyperthyroidism
- polymyositis/dermatomyositis: autoimmune conditions that cause pain, weakness, and inflammation of the muscles, and can include a rash
Labs can differ in their standards for a positive test. Talk with your doctor about what your levels mean and how your symptoms may be explained by the presence of ANA. If your ANA test comes back positive, your doctor will need to run more tests in order to help determine if the results are related to a specific condition.
The ANA test is especially helpful in diagnosing lupus. More than 95 percent of people with lupus will test positive. However, not everyone that tests positive for ANA has lupus, and not everyone with lupus tests positive for ANA. Therefore, the test can’t be used as the only method of diagnosis.
Speak with your doctor about additional tests that can be done to determine if there is an underlying cause for the increased ANA in your blood.