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Updated: Aug 14, 2026
Anti-Nuclear Antibody Screening Using HEp-2 Cells
Published on: June 23, 2014
Antinuclear antibodies in children: clinical signification and diagnosis utility
Insights
Antinuclear antibody (ANA) testing in children shows a high prevalence, but positive results often indicate musculoskeletal issues rather than connective tissue diseases or autoimmune hepatitis when clinical suspicion is low. Careful interpretation is key for diagnosis.
Area of Science:
- Pediatric immunology
- Autoimmune disease diagnostics
- Clinical pathology
Background:
- Antinuclear antibodies (ANA) tests screen for connective tissue diseases (CTD) and autoimmune hepatitis in children and adults.
- Interpreting positive ANA results in pediatric patients requires careful consideration of clinical context.
Purpose of the Study:
- To evaluate the clinical significance and diagnostic utility of positive ANA tests in children.
- To assess the range of conditions associated with ANA positivity in a pediatric cohort.
Main Methods:
- Retrospective analysis of 102 ANA tests from pediatric patients over 2 years.
- ANA screening via indirect immunofluorescence (IIF) on HEp-2 cells.
- Specificity testing using IIF on Crithidia luciliae and immunodot assays for positive results (cut-off 1:80).
Main Results:
- 55.9% of pediatric ANA tests were positive, with 38 patients analyzed.
- Joint pain was the most frequent symptom (55.3%).
- Musculoskeletal diseases were most common (42.1%) among positive ANA cases; other diagnoses included systemic lupus erythematosus, overlap syndrome, and various other conditions, with 15 patients having no confirmed diagnosis or non-autoimmune diseases.
Conclusions:
- ANA prevalence is relatively high in children.
- Positive predictive value for CTD or autoimmune hepatitis is low with low pretest probability.
- ANA testing can be a valuable supplementary diagnostic tool and aid in clinico-biological monitoring within the appropriate clinical context.
Background:
Antinuclear antibodies (ANA) test is used to screen adults as well as children for connective tissue diseases (CTD) and autoimmune hepatitis. However, interpretation of ANA positivity can be delicate.
Aim:
to determine clinical significance and diagnosis utility of ANA positivity in children.
Methods:
Patients from a general pediatric department with ANA positive results were included (follow-up period of 2 years). ANA screening was performed by indirect immunofluorescence (IIF) on HEp-2 cells substrate (BioSystems®). In case of ANA positivity (cut-off: 1:80), the specificity was determined by IIF on Crithidia luciliea substrate (BioSystems®) and immunodot (Euroimmun®).
Results:
Among 102 ANA tests, 55 (53,9%) were positive. We recorded the data of 38 patients (age average: 9,5 years - sex ratio: 0.72). The most frequent signs were join pain (55,3%). ANA titer varied between 1:80 (39,5% of cases) and 1:1280 (2,6% of cases). Typing was negative in 89,5% of cases. The majority (42,1%) of children with positive ANA test had musculoskeletal diseases. The others (57,9%) had systemic lupus erythematosus(n=2), overlap syndrome(n=1), rheumatoid purpura(n=2), idiopathic thrombocytopenic purpura(n=1), coeliac disease(n=1) or non-autoimmune diseases/no confirmed diagnosis(n=15).
Conclusions:
ANA prevalence in children was relatively high. When the pretest probability is low, the positive predictive value for CTD or autoimmune hepatitis is low. However, depending on the clinical context, ANA detection can represent a supplement diagnostic tool for these diseases and/or can lead to a clinico-biological monitoring.
