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Arthritis and Rheumatism

Can a Positive ANA be Normal in Some People?

05/30/2008

Question:

My son has suffered from bloating and chronic constipation since 2001 when he was 17. Colonoscopy, lower GI, etc. proved negative, but during blood work in 2001 a ANA test resulted in a reading of 1:1280. Other than the constipation and significant weight loss, there were no other symptoms of an autoimmune disease at that time. He has always had a red rash across his cheeks (not his nose) and did have Fifth`s disease at age 5 (the rash stayed). We were told that some people have ANA present in their systems naturally. He learned to live with the symptoms. He is now 24 and suffering from fatigue, excessive sleepiness, and a tingling sensation in his finger tips, as well as the chronic constipation. He has an appointment with our family doc in 2 weeks. What questions/tests should he ask/request? Should we have questioned the positive ANA results in 2001?

Answer:

An elevated anti-nuclear antibody (ANA) test may be present in up to 30% of individuals in a "normal" population. Typically, this is at a titer equal to or less than 1:40. An ANA titer of 1:320 may be present in about 3% of individuals in a "normal" population. In your son's instance, the ANA titer of 1:1,280 was definitively high, but it lacked and lacks any strong diagnostic power. If the ANA is still highly elevated, then a referral to a Rheumatologist to rule out rheumatic ANA-associated diseases is a reasonable request. Keep in mind, elevated ANA's are not only found in rheumatic diseases. Your son's rheumatologist may be able to refer you to a different specialist if he/she feels that the ANA is related to another disease process.

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Response by:

Raymond  Hong, MD, MBA, FACR Raymond Hong, MD, MBA, FACR
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University