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Updated: Aug 23, 2026
Anti-Nuclear Antibody Screening Using HEp-2 Cells
Published on: June 23, 2014
Clinical utility of antinuclear antibody tests in children
Julie L McGhee1, Lauren M Kickingbird, James N Jarvis
1Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, OK, USA. julie-mcghee@ouhsc.edu
Insights
Antinuclear antibody (ANA) tests can help diagnose systemic lupus erythematosus (SLE) in children, especially with high titers and older age. However, ANA tests are not useful for diagnosing juvenile rheumatoid arthritis (JRA).
Area of Science:
- Pediatric Rheumatology
- Immunology
- Diagnostic Utility
Background:
- Antinuclear antibody (ANA) tests are commonly used to screen children for chronic inflammatory diseases like systemic lupus erythematosus (SLE).
- The diagnostic value of ANA tests is limited due to a high rate of positive results in healthy children.
Purpose of the Study:
- To evaluate the clinical utility of ANA tests in identifying rheumatic diseases in children.
- To identify specific clinical signs or symptoms that improve the diagnostic accuracy of ANA tests in pediatric patients.
Main Methods:
- Retrospective analysis of 509 new patient referrals with positive ANA test results.
- Comparison of demographic data, presenting complaints, and ANA titers among children diagnosed with juvenile rheumatoid arthritis (JRA), SLE, and other conditions.
Main Results:
- Of 110 children with positive ANA tests, 10 were diagnosed with SLE, 1 with mixed connective tissue disease, and 18 with JRA.
- ANA tests were not effective in differentiating JRA from other musculoskeletal conditions.
- Children with SLE were older and more likely to present with a non-urticarial rash compared to the comparison group.
- High ANA titers (>/=1:1,080) had a positive predictive value of 1.0 for SLE, while low titers (
Conclusions:
- Age and ANA titer are valuable in distinguishing pediatric SLE from other conditions.
- ANA testing has no diagnostic utility for diagnosing or excluding JRA in children.
Background:
Antinuclear antibody (ANA) tests are frequently used to screen children for chronic inflammatory diseases such as systemic lupus erythematosus (SLE). However, the diagnostic utility of this test is limited because of the large number of healthy children who have low-titer positive tests. We sought to determine the clinical utility of ANA tests in screening children for rheumatic disease and to determine whether there are specific signs or symptoms that enhance the clinical utility of ANA tests in children.
Methods:
We undertook a retrospective analysis of 509 new patient referrals. Charts of patients referred because of results of ANA testing were selected for further analysis. Children with JRA, SLE, and other conditions were compared using demographic data, chief complaints at the time of presentation, and ANA titers.
Results:
One hundred ten patients were referred because of an ANA test interpreted as positive. Ten patients were subsequently diagnosed with SLE. In addition, we identified one patient with mixed connective tissue disease, and an additional child with idiopathic Raynaud's phenomenon. Eighteen children of the children referred for a positive ANA test had juvenile rheumatoid arthritis (JRA). Another 80 children with positive ANA tests were identified, the majority of whom (n = 39, 49%) had musculoskeletal pain syndromes. Neither the presence nor the titer of ANA served to distinguish children with JRA from children with other musculoskeletal conditions. Children with JRA were readily identified on the basis of the history and physical examination. Children with SLE were therefore compared with children with positive ANA tests who did not have JRA, designated the "comparison group." Non-urticarial rash was more common in children with SLE than in children without chronic inflammatory disease (p = 0.007). Children with SLE were also older (mean +/- sd = 14.2 +/- 2.5 years) than the comparison group (11.0 +/- 3.6 years; p = 0.001). ANA titer was also a significant discriminator between children with SLE and children without chronic inflammatory disease. The median ANA titer in children with SLE was 1: 1,080 compared with 1:160 for other children (p < 0.0001). ANA titers of >/=1,080 had a positive predictive value for SLE of 1.0 while titers of
Conclusion:
Age and ANA titer assist in discriminating children with SLE from children with other conditions. ANA tests are of no diagnostic utility in either making or excluding the diagnosis of JRA.
