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ANA Screening (Immunofluorescence)
Fluorescent Antinuclear Antibody, FANA
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Overview
If the doctor suspects an autoimmune disorder, they may advise ANA screening (immunofluorescence) test. This test helps detect the presence of antinuclear antibodies in the blood that may help determine the cause of the symptoms.
The indirect immunofluorescence method is a traditional method that is regarded as a gold-standard technique. Compared to other methods, the ANA screening (immunofluorescence) test is a highly sensitive test to detect the presence of antinuclear antibodies.
The immune system protects the body from harmful pathogens through various methods. One of these methods is by producing antibodies against potential pathogens. Sometimes the immune system identifies the healthy cells in the body as antigens and starts producing antibodies against them, this phenomenon is autoimmunity. The antibodies produced as a result are termed "autoantibodies".
Antinuclear autoantibodies are those that act against the nucleus of a cell, which is the brain of the cell and is responsible for various vital actions of a cell. When the nucleus of the cell is damaged, the overall cell function is disturbed, which on a larger scale, may lead to inflammation of the affected part of the body. This phenomenon has been observed in various autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and Sjogren’s syndrome, to name a few.
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Risk Assessment
Rheumatoid Arthritis, Systemic Lupus Erythematosus, Sjogren’s Syndrome, Polymyositis, Scleroderma
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Ranges
ANA positive at low titres of 1:40 and 1:80 may be observed in both healthy individuals and those with autoimmune conditions. On the other hand, ANA positivity at high titres, such as 1:160, may be considered highly accurate and may be present only in those with an autoimmune disorder.
As a result, ANA positivity at low titres is of less importance in healthy individuals, whereas ANA positivity at high titres may be considered in those with suspected autoimmune conditions. Positive titres equal to or greater than 1:160 or higher are strongly associated with autoimmune disorders.
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Test Result Interpretation
The ANA titres are of diagnostic importance for certain disorders such as drug-induced lupus, mixed connective tissue disorder, and autoimmune hepatitis. A diagnosis of Systemic Lupus Erythematosus is unlikely if ANA is negative. In cases of clinical suspicion of systemic sclerosis, Sjogren's syndrome, or polymyositis, an ANA test is recommended, but the sensitivity and specificity of the test vary.
The ANA tests are also interpreted according to the pattern exhibited by the ANAs, such as nucleolar, speckled, homogenous, or peripheral patterns. These patterns can be correlated by the physician to certain diseases that help them arrive at a certain diagnosis. SLE may exhibit a homogeneous, speckled, or peripheral pattern. A granular, peripheral, nucleolar, or centromere pattern may be observed in those with systemic sclerosis. Sjogren’s syndrome may show a granular or speckled pattern, whereas polymyositis is evident by a granular pattern.
It has to be noted that the ANA IFA test may be positive for numerous conditions. Hence this test cannot be termed diagnostic in the majority of cases. Testing for specific antibodies may be required for a more accurate diagnosis. If ANA IFA is negative, testing for specific antibodies is indicated only in cases of strong clinical suspicion. Moreover, positive ANA tests are not uncommon in healthy individuals and those with certain infectious conditions and cancer.
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