Adults
Positive ANA without symptoms
The most common source of unnecessary referrals. About 1 in 3 healthy people test positive at 1:40.
What to look for
- In healthy people, about 32% are positive at 1:40, 13% at 1:80 and 5% at 1:160 (Tan 1997)
- Low titers and a dense fine speckled (DFS70) pattern are common in healthy people
- No rash, arthritis, serositis, Raynaud's, cytopenias or abnormal urinalysis
What to do
- Document why the ANA was ordered, and the titer and pattern.
- Check a CBC, metabolic panel and urinalysis. If all are normal and there are no symptoms, reassure.
- At higher titer (1:160 or above), check an ENA panel and anti-dsDNA. Avoid ordering ANA sub-serologies when the ANA is negative and suspicion is low.
Refer if
- Disease-specific antibodies are positive (anti-dsDNA, Sm, RNP, Scl-70, centromere, or SSA/Ro in pregnancy)
- Unexplained cytopenias, proteinuria or hematuria
- New systemic symptoms develop
About this urgency level
Common in referral queues. Many can be managed in primary care with the guidance below, though some rheumatology practices are happy to see them. A pre-referral e-consult can help decide.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.