Overview
Typically, if a person tests positive for the antinuclear antibody, it means only that the person could have lupus. Further tests are needed to determine if a person actually has lupus. Those include tests for double-stranded DNA (dsDNA), Sm (Smith), Ro/SSA (Sjogren’s syndrome A), La/SSB (Sjogren’s syndrome B), and RNP (ribonucleoprotein) antibodies.
Up to 15% of otherwise healthy people can have a low titer positive ANA. Other tests for inflammation markers (ESR, CRP) and complement levels (C3, C4), may also be obtained.
If the ANA test comes back negative, then it’s highly unlikely that the person has lupus.
However, in rare instances, a person will have a negative ANF IF test result but exhibit other traits consistent with lupus.
Does ANA-Negative Lupus Exist?
The general consensus is that ANA-negative lupus is very rare—and is more a term given to patients with “lupus-like” disease. Some physicians might call it “mixed connective tissue disease,” “undifferentiated connective tissue disease,” or “forme fruste lupus”—or “hidden lupus.” Each has specific and separate meaning and describes different forms of illness.
The most current diagnostic criteria for SLE (2019 ACR/EULAR criteria) state that a patient has to have a ANA at a titer of ≥1:80 at least once to be characterized as lupus, otherwise the disease cannot be classified as lupus.
Put another way, physician Michael D. Lockshin, MD, writes: “The answer to the question, ‘Does ANA-negative lupus exist?’ is technically ‘yes,’ with a large number of buts, and ifs, and whens. Another answer is that the question is not very important. It is never critical to say definitively that a given patient does or does not have lupus. What is important is to evaluate the current symptoms, to put the symptoms into an overall context that includes blood tests, duration of symptoms, other illnesses, and medications, and to develop a treatment plan based on the total information rather than on a blood test alone.”
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