Quick answer
What Is Antinuclear Antibody Test?
The ANA test looks for antibodies that mistakenly attack the nuclei of the body's own cells. It is an initial step in looking for lupus and other autoimmune diseases. A positive result does not always mean illness, because some healthy people also test positive, while a negative result makes lupus very unlikely.
Sources01 / Understanding the procedure
About Antinuclear Antibody Test
What Is the ANA Test
Antinuclear antibodies (ANA) are antibodies that mistakenly attack the nucleus of the body's own cells. These antibodies are often found in autoimmune diseases such as lupus, Sjögren's syndrome, scleroderma, and mixed connective tissue disease. The ANA test is used as the initial screening test when your doctor suspects an autoimmune disease.
How It Works in Brief
Your serum is diluted step by step and then placed on test cells on a glass slide. If ANA is present, the antibodies attach to the cell nuclei and glow when a fluorescent substance is added and the slide is viewed under a special microscope. The staff records up to which dilution the cell nuclei still glow and what the glow pattern looks like.
Reading the Results
- Negative: the cell nuclei do not glow. Lupus becomes very unlikely, because almost all lupus patients have a positive ANA.
- Titer: shows up to which dilution ANA can still be detected, for example 1:80, 1:160, or 1:320. The higher the titer, the more likely an autoimmune disease is present.
- Pattern: the shape of the glow, for example homogeneous, speckled, nucleolar, or centromere. The pattern helps your doctor choose follow-up tests.
A positive ANA with a low titer is fairly common in healthy people, especially women and older adults. For this reason, ANA results are always read together with symptoms. If the result is positive, your doctor usually follows up with more specific tests, such as anti-dsDNA, anti-Sm/RNP, or other antibody panels.
ANA and the Heart
Autoimmune diseases can affect the heart, for example inflammation of the sac around the heart (pericarditis), inflammation of the heart muscle (myocarditis), valve thickening, and pulmonary hypertension that strains the right side of the heart. For this reason, the ANA test is often part of the workup for pericarditis or pulmonary hypertension when the cause is unclear.
Some heart and blood pressure medicines, such as hydralazine and procainamide, can make the ANA positive and cause drug-induced lupus. In pregnant women with a positive ANA, follow-up tests may find anti-Ro antibodies, which are linked to a risk of congenital heart block in the baby.
02 / Understanding the procedure
When Is This Procedure Considered?
A doctor may consider this procedure in the situations below. The decision is always made after a thorough assessment.
- Symptoms Suggesting an Autoimmune DiseaseSuch as joint pain, rash, prolonged fever, or recurrent mouth ulcers.
- Pericarditis or Myocarditis Without a Clear CauseTo look for an autoimmune disease as the cause.
- Pulmonary Hypertension Without a Clear CausePart of the search for connective tissue diseases such as scleroderma.
- Fingers Turning Pale or Blue in the ColdEspecially with swollen fingers or thickened skin.
- Suspected Drug-Induced LupusFor example when joint pain or fever appears while taking hydralazine or procainamide.
- Pregnancy Planning with an Autoimmune DiseaseAs an initial step before follow-up antibody tests such as anti-Ro.
Situations to Consider First
- No Supporting SymptomsA low positive ANA is often found in healthy people, so testing without symptoms rarely helps.
- Certain MedicinesHydralazine, procainamide, and anti-TNF medicines can make the ANA positive.
- Acute Infection or InflammationCan cause a temporary positive ANA, so the result is read together with your condition.
- Older AgeA positive ANA with a low titer is found more often with increasing age.
- Different Laboratory MethodsResults from other methods can differ from the test cell method, so results should be compared using the same method.
03 / Before the procedure
How Should You Prepare?
The ANA test uses a blood sample and does not require fasting.
Eating and drinking. Eat and drink as usual, unless another test done at the same time requires fasting.
Medicines. Take your medicines as usual unless your doctor tells you otherwise. Bring a list of your medicines, especially if you take hydralazine, procainamide, or anti-TNF medicines.
Important information. Tell the staff if you are pregnant or currently have a fever or an infection.
Previous results. Bring any ANA or other autoimmune test results you have had before.
Unsure about the preparation instructions? Ask our team before the procedure.
04 / During the procedure
How Is the Procedure Done?
The blood draw is usually finished within 10 minutes. Results are usually available within a few days.
Identity Check
The staff matches your identity with the test request and asks about the medicines you are taking.
Blood Draw
Blood is drawn from a vein at the inner elbow into a serum tube.
Testing in the Laboratory
The serum is diluted step by step and placed on test cells. The staff looks at the glow of the cell nuclei with a fluorescence microscope, then records the titer and pattern.
Reading the Results
Your doctor reads the titer and pattern together with your symptoms, then decides whether follow-up antibody tests are needed.
05 / Benefits and risks
Benefits and Risks Should Be Discussed Together.
Every medical procedure has benefits and risks. Your doctor will explain both for your situation before the procedure.
Benefits You Can Expect
- Initial Screening TestA simple initial step in looking for autoimmune diseases.
- A Negative Result Almost Rules Out LupusAlmost all lupus patients have a positive ANA.
- Guiding Follow-Up TestsThe titer and pattern help your doctor choose the right tests.
- Helping Find the Cause of Heart InflammationPart of the workup for pericarditis, myocarditis, and pulmonary hypertension.
- Only a Blood Sample NeededNo procedure is needed other than a blood draw.
The benefits of a procedure are not a promise of a cure. Ask how the results will affect your care plan.
Risks You Should Know
- Minor Pain or BruisingAt the needle site, usually mild and quick to fade.
- Brief Dizziness or FaintingSome people feel dizzy during a blood draw. Tell the staff so you can lie down.
- Positive Without DiseaseA low positive ANA can be found in healthy people, so the result needs to be read together with symptoms.
- Infection at the Puncture SiteVery rare because the skin is cleaned and the equipment used is sterile and single-use.
Risks can differ from person to person. A full explanation and consent are given after an individual assessment.
06 / After the procedure
What Is Recovery Like?
There is no recovery period. You can return to your activities right away.
Puncture site. A small bruise is normal and fades within a few days.
If the result is positive. Your doctor may order follow-up tests, such as anti-dsDNA, anti-Sm/RNP, complement, urine tests, or echocardiography if you have heart symptoms.
If the result is negative. Lupus becomes very unlikely, but your doctor still assesses your symptoms to look for other causes.
Warning signs. Go to the emergency room right away or contact the medical team if you have:
- Sharp chest pain that worsens when you breathe in or lie down
- Shortness of breath that keeps getting worse, or fainting during activity
- Palpitations with dizziness
- Swelling in the face or legs with reduced or red-colored urine
Know the Signs That Need Prompt Care.
Follow the team's guidance on warning signs. If severe or sudden symptoms appear after the procedure, go to the nearest emergency department right away or call Heart Attack Center 1500 258.
07 / Team and support
Doctors and Procedure Support
The doctors below are listed for this procedure. Listed by name, not by ranking.
dr. Debby C. Soemitha, Sp.PD
Internal Medicine
Clinical focusDiabetes and Diabetes Complications · Obesity and Metabolic Disease
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Dr. med. dr. Denio A. Ridjab, Sp.JP(K)
Interventional Cardiology
Coronary Intervention Procedures +2 centers
Clinical focusInterventional Cardiology · Coronary Artery Disease
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dr. Santi R. Dewayanti, Sp.P
Pulmonology
Clinical focusLung and Respiratory Disease · Asthma and COPD
View Profile08 / Common questions
Before You Plan the Procedure.
Frequently asked questions about the ANA test. What the results mean for your condition is explained by your doctor.
What does a positive ANA mean?
A positive ANA means there are antibodies against cell nuclei in your blood. This can be found in autoimmune diseases such as lupus, but also in some healthy people, during an infection, or because of certain medicines. For this reason, your doctor reads the titer, the pattern, and your symptoms before deciding on follow-up tests.
Can healthy people have a positive ANA?
Yes. About 1 in 10 healthy people have a positive ANA with a low titer, and it is more common in women and older adults. The majority of them never develop an autoimmune disease. For this reason, a positive ANA without supporting symptoms is usually just monitored, not treated.
What do the ANA titer and pattern mean?
The titer shows how far the serum can be diluted before ANA is no longer visible, for example 1:80 or 1:320. The higher the titer, the more likely an autoimmune disease is present. The pattern is the shape of the glow in the cell nuclei, such as homogeneous or speckled, which helps your doctor choose follow-up tests.
If my ANA is negative, does that mean I do not have lupus?
Almost all lupus patients have a positive ANA, so a negative result makes lupus very unlikely. However, a negative ANA does not rule out all autoimmune diseases or other causes of your symptoms. Your doctor still assesses your symptoms and other test results to look for the cause of those symptoms.
Does ANA need to be rechecked regularly?
Usually not. The ANA titer does not follow disease activity, so it is not used to monitor lupus. This test is usually done only once to help with diagnosis. For monitoring, your doctor uses other tests such as anti-dsDNA, complement C3 and C4, and urine tests that are repeated regularly.
How is ANA related to the heart?
Autoimmune diseases marked by a positive ANA can affect the sac around the heart, the heart muscle, and the valves, or cause pulmonary hypertension. For this reason, an ANA test is often requested when the cause of pericarditis or pulmonary hypertension is unclear. In pregnancy, follow-up tests may find antibodies linked to congenital heart block in the baby.
Sources and Medical Review
Translated from the Indonesian edition medically reviewed by dr. Debby C. Soemitha, Sp.PD.
Sources as cited in the Indonesian edition.
- Agmon-Levin N, Damoiseaux J, Kallenberg C, et al. International recommendations for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies. Ann Rheum Dis. 2014;73(1):17-23.
- Damoiseaux J, Andrade LEC, Carballo OG, et al. Clinical relevance of HEp-2 indirect immunofluorescent patterns: the International Consensus on ANA patterns (ICAP) perspective. Ann Rheum Dis. 2019;78(7):879-889.
- Tan EM, Feltkamp TEW, Smolen JS, et al. Range of antinuclear antibodies in "healthy" individuals. Arthritis Rheum. 1997;40(9):1601-1611.
- Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis Rheumatol. 2019;71(9):1400-1412.
- Pisetsky DS, Lipsky PE. New insights into the role of antinuclear antibodies in systemic lupus erythematosus. Nat Rev Rheumatol. 2020;16(10):565-579.
- Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618-3731.