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Use: Assay for screening for ANAs in patients suspected of having connective tissue disease. The indirect immunofluorescent test has three elements to consider in the result:
1. Positive or negative fluorescence. A negative test is strong evidence against a diagnosis of SLE but not conclusive.
2. The titer (dilution) to which fluorescence remains positive (provides a reflection of the concentration or avidity of the antibody). Many individuals, particularly the elderly, may have low titer ANA without significant disease substantiated after work-up.
3. The pattern of nuclear fluorescence (reflecting specificity for various diseases).
Cytoplasmic (non-nuclear) staining patterns may also be noted with the IFA methodology.
Multiplex ANA detects up to 11 specific antibodies of the 100+ antibodies that may be found in the ANA IFA.
Limitations: Males and females older than 80 years of age have a 50% incidence of low titer ANA. Various medications can induce a "lupoid" condition and elevated ANA titers. Usually the titer decreases following removal of the drug. Low antibody levels may be found in diseases other than connective tissue disease.
Methodology: Indirect Immunofluorescence Assay (IFA) and Multiplex Flow Immunoassay
If reflex test is performed, additional charges/CPT code(s) may apply.
