Anti-nuclear antibody
From IDWiki
Background
- Refers to antibodies that react to nuclear proteins
- General screen, sometimes followed by assessing for specific antibodies
- Antigens that are insoluble in saline: double-stranded DNA, deoxyribonucleoprotein (DNP), histones
- Antigens that are soluble in saline (or extracted; ENA): anti-Smith, anti-RNP, anti-Ro/La, anti-Scl-70
- May be measured by indirect immunofluorescence assay (IIF) (the gold standard), enzyme-linked immunosorbent assay (EIA), or other technologies
- The pattern on immunofluorescence can be speckled, homogeneous, mixed, nucleolar, centromere, or peripheral
Interpretation
- Healthy people can have a 1:40 titre (25 to 45% of health people), 1:80 titre (10 to 15%), or even 1:160 titre (5%)
- Increases with age, and titres are generally higher in women
- Systemic lupus erythematosus
- ANA assay was essentially developed as a screening tool for SLE
- It is 90 to 95% sensitive
| Disease | % Positive | Titre | Common Patterns |
|---|---|---|---|
| SLE (active) | 95 | high | homogeneous > speckled > rim |
| SLE (in remission) | 90 | moderate-high | homogeneous > speckled |
| MCTD | 93 | high | speckled > nucleolar |
| Systemic sclerosis or CREST | 85 | high | speckled > centromere > nucleolar |
| Sjögren syndrome | 48 | moderate-high | speckled > homogeneous |
| Dermatomyositis/Polymyositis | 61 | low-moderate | speckled > nucleolar |
| Rheumatoid arthritis | 41 | low-moderate | speckled |
| Drug-induced lupus | 95 | low-moderate | homogeneous > speckled |
| Pauciarticular JIA | 71 | low-moderate | speckled |
| Graves disease | 50 | low-moderate | speckled |
| Hashimoto thyroiditis | 46 | low-moderate | speckled |
| Autoimmune hepatitis | 63–91 | low-moderate | speckled |
| Primary biliary cirrhosis | 10–40 | low-moderate | speckled |
- Infectious causes also exist, such as HIV, HBV, HCV, parvovirus B19, EBV and CMV1, COVID-19, tuberculosis, syphilis, bartonellosis, and scrub typhus and rickettsioses2
- Generally low titres and transient, resolving with the acute infection
Further Reading
- Antinuclear Antibody Tests. Clin Lab Med. 2019 Dec;39(4):513-524. doi: 10.1016/j.cll.2019.07.001. PMID: 31668266.
References
- ^ Shira Dor, Itai Harris, Ofek Arviv, Daniel Boleslavsky, Eleanor Zeruya, Michal Tepperberg Oikawa, Michal Brodavka, Uri Manor. Antinuclear antibody positivity in acute Epstein–Barr virus and cytomegalovirus infections. Autoimmunity. 2025;58(1). doi:10.1080/08916934.2025.2596701.
- ^ Jae Hyoung Im, Moon-Hyun Chung, Young Kyoung Park, Hea Yoon Kwon, Ji Hyeon Baek, Seung Yun Lee, Jin-Soo Lee. Antinuclear antibodies in infectious diseases. Infectious Diseases. 2019;52(3):177-185. doi:10.1080/23744235.2019.1690676.
