Choosing Wisely:

Don’t order ANA and other autoantibody testing on a child unless there is strong suspicion or specific signs of autoimmune disease.

Rationale and Comments: The ANA has a high sensitivity for only one disease, systemic lupus erythematosus, but has very poor specificity for systemic lupus erythematosus and every other rheumatic disease. Therefore, it is not useful or indicated as a general screen of autoimmunity. A positive ANA may occur secondary to polyclonal activation of the immune system following an infection, or it may be positive without any identifiable reason/disease in up to 32% of the population. Limiting patients on which to order ANA would reduce unnecessary physician visits and laboratory expenses, as well as parental anxiety. “Lupus panels” and other similar panels should also not be ordered without concerns for specific autoimmune disease. Additionally, since the ANA may always be positive and may fluctuate in titer, it is not recommended to retest it unless there is some new clinical concern.
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Rheumatology
  • Sources:
  • Expert consensus
  • Disciplines:
  • Pediatric
  • Rheumatologic
  • References: • Cabral DA, Petty RE, Fung M, Malleson PN. Persistent antinuclear antibodies in children without identifiable inflammatory rheumatic or autoimmune disease. Pediatrics. 1992;89(3):441-444.
    • Deane PMG, Liard G, Siegel DM, Baum J. The outcome of children referred to a pediatric rheumatology clinic with a positive antinuclear antibody test but without an autoimmune disease. Pediatrics. 1995;95(6):892-895.
    • Hilario MOE, Len CA, Roja SC, Terreri MT, Almeida G, Andrade LEC. Frequency of antinuclear antibodies in healthy children and adolescents. Clinical Pediatrics. 2004;43:637-642.
    • Malleson PN, Sailer M, Mackinnon MJ. Usefulness of antinuclear antibody testing to screen for rheumatic disease. Arch Dis Child. 1997;77:299-304.

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