Wednesday, 17 Oct 2018

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ANA Rules

http://rheumnow.com/sites/default/files/ANA%20Rules.pptx

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Rheumatologists' Comments

I don’t agree with any of the rules. 1) doorder ana if no clinical lupus.ANA may be helpful for RA, sjogrrns, scleroderma, myositis 2)repeat ANA. It comes and goes 3)order subserologies. ENA, SSA,SSB. Very helpful may show lupus. 4) absolutely not. Look at new studies showing up to 24% Ana negativity in established lupus. 5) Ana neg RA, other ctd, even sle is seen. 6) do refer low pos Ana if PAIN is present. It is very helpful in outcome, response to dmard. Thank you.
1. You cannot diagnose RA with an ANA. ANA are absent in half of PSS and PM/DM patients. 2. If ANA comes and goes - your doing it too often and finding useless information. 3. If you regularly diagnose and treat lupus with a negative ANA then your neglecting 50 years of ANA research. 4. Seems i have rigid rules for the use of ANA that you do not. Best wishes JJC
Dr Cush thank you for your reply it is very nice to interact with you I follow your weekly reviews religiously and appreciate them. 1) Ana may be neg in non lupus ctd but when positive it helps. So if no clinical lupus, still order Ana if ctd is suspected. 2)I don’t think Ana that comes and goes is useless. I’ve diagnosed ctd including lupus in currently Ana neg past Ana pos or vice versa pts. So if it is neg it may be pos in future or may have been pos in past. That changes my approach if cro is also elevated especially. 3)I dontctegularly diagnose or treat lupus with a neg Ana. I don’t believe in ruling out lupus if clinical signs are present Ana neg due to #2 above.4) I think rules can be bent or may prove less rigid my 18 years in Rheumatology has taught me this . Maybe another 18 years will teach me the opposite. I will live and learn, again very nice talking with you Ulker.