Anti-Nuclear Antibody (ANA) and Anti-Double Stranded DNA (Anti-ds DNA) Tests by Family Physicians
Choosing Wisely Canada Recommendation
- Don’t order ANA as a screening test in patients without specific signs or symptoms of systemic lupus erythematosus (SLE) or another connective tissue disease.
- The number of ANA tests ordered in NL relative to the incidence of connective tissue disease is very high (> 12,000 tests/year). 57% of tests were ordered by Family Physicians (FPs).
- ANA is not indicated unless a connective tissue disease is a significant possibility. The majority of tests in NL were ordered in low risk groups: males and females > 60 years of age.
- ANA > 1:80 is required to consider the presence of SLE. False positive results are quite common and as such, it is recommended that ANA testing be undertaken in people in whom a connective tissue disease is a strong possibility.
- ANA is not indicated as a screening test to evaluate fatigue, back pain, and other musculoskeletal pain in the absence of other clinical manifestations to suggest connective tissue disease, nor is it indicated to confirm a diagnosis of rheumatoid arthritis or osteoarthritis.
- ANA testing need only be ordered once.
- ANA costs $24 per test.
The number of ANA and anti-ds DNA tests ordered relative to the incidence of connective tissue diseases is very high.
From 1 Apr 2016 – 31 Mar 2018 (2 years) there were 24,428 ANA and 7,909 anti-ds DNA tests performed in NL. The rates of testing are 23,448 ANA tests annually/million population and 7,461 anti-ds DNA/million.
- From 1 Apr 2016 – 31 Mar 2018, there were a total of 24,428 ANA tests performed in NL.
- 57% were ordered by FPs.
- 7% were repeat tests.
- 33% of ANA tests were in male patients and 32% in people >60 years.
- 53% of tests were in low risk groups: males and people >60 years.
- 48% of anti-ds DNA were in low risk groups.
- 48% of tests ordered by FPs were in groups at low risk for SLE connective tissue disease.
- From 1 Apr 2016 – 31 Mar 2018, 50 FPs ordered ≥50 ANA tests.
What You Can Do
- Only test patients with signs or symptoms of SLE or other connective tissue diseases (CTD).
- CTD patients typically present with at least one of the following clinical findings unexplained by other causes:
- pleurisy or pericarditis
- photosensitive rash
- laboratory evidence of renal disorder
- hemolytic anemia, immune thrombocytopenia or neutropenia
- skin changes of scleroderma, dermatomyositis or vasculitis
- clinical and laboratory evidence of myositis
- Raynaud’s phenomenon
- neurologic signs
- Check out Choosing Wisely Canada’s Rheumatology Recommendations
- Other References: British Columbia Guidelines