Anti-nuclear antibody testing in children: How much is really necessary?
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Updated: Nov 22, 2025
Anti-Nuclear Antibody Screening Using HEp-2 Cells
Published on: June 23, 2014
Fatih Haslak1, Mehmet Yildiz1, Ilayda Altun2
1Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa Cerrahpasa Medical School, Istanbul, Turkey.
Insights
Anti-nuclear antibody (ANA) testing in children often lacks utility. Pediatric ANA testing is rarely effective for diagnosing autoimmune diseases, with most children showing no underlying conditions.
Area of Science:
- Pediatric Rheumatology
- Clinical Immunology
- Diagnostic Test Utility
Background:
- Anti-nuclear antibody (ANA) testing is frequently used by pediatricians for musculoskeletal complaints.
- The clinical utility of ANA testing in childhood evaluations is often limited.
Purpose of the Study:
- To evaluate the effectiveness of ordering ANA testing in pediatric patients.
- To determine the diagnostic yield of ANA testing in children presenting with musculoskeletal symptoms.
Main Methods:
- Retrospective analysis of children with positive ANA findings between 2008-2020.
- Exclusion of patients with <1-year follow-up or pre-existing autoimmune/rheumatic diseases.
- Data collection via medical records and phone verification with parents.
Main Results:
- 94.1% of 358 eligible pediatric patients had no underlying disease.
- Musculoskeletal symptoms were the most common reason for ANA testing (62.8%).
- No patients developed autoimmune conditions or ANA-associated rheumatic diseases; Hypermobility syndrome was the most common diagnosis.
Conclusions:
- ANA testing in children has limited effectiveness as a general screening tool.
- Recommend ANA testing only for strong suspicion of specific autoimmune diseases like lupus.
- Avoid routine ANA screening for non-specific musculoskeletal complaints in pediatric populations.
Background:
Anti-nuclear antibody (ANA) testing is most commonly ordered by general pediatricians to evaluate children with musculoskeletal system complaints. Given the limited utility of the test, we aimed to estimate the effectiveness of ordering ANA testing in childhood.
Methods:
Children referred to our department to be examined due to positive ANA findings between 2008 and 2020 were included in the study. Those with less than one-year follow-up period, those with previously known rheumatic or autoimmune disease, and those diagnosed as an autoimmune and/or rheumatic disease at the first visit were excluded. Data were obtained from their medical records, retrospectively. The parents of all of the patients were called via phone, data were verified, and missing information was collected.
Results:
Three hundred and fifty-eight patients (230 females) were eligible for the study. The median age of positive ANA findings was 9.31 (1.3-17.86) years and the median follow-up duration was 4.85 (1-11.91) years. Most of the patients had no underlying disease (n = 337, 94.1%). The most common reason for ordering ANA testing was to evaluate musculoskeletal system symptoms (n = 225, 62.8%). None of our patients referred to us due to positive ANA findings developed any autoimmune conditions or ANA associated rheumatic disease. Hypermobility syndrome is the most common final diagnosis among our ANA-positive patients.
Conclusion:
We suggest that instead of using it as a screening tool, ANA testing should be performed only if there is a strong suspicion of autoimmune diseases or certain rheumatic conditions, such as systemic lupus erythematosus.
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