Table of ContentsView AllTable of ContentsWhat Is Lupus?DiagnosisCurrent Debate
Table of ContentsView All
View All
Table of Contents
What Is Lupus?
Diagnosis
Current Debate
ANA-negative lupus is a rare situation in which a person is said to havelupus—otherwise known assystemic lupus erythematosus(SLE)—but a blood test used to confirm lupus comes back negative. The test, known as anantinuclear antibody (ANA) test, detects a protein called antinuclear antibody (ANA) typically found in people with lupus and otherautoimmune diseases.
Although almost everyone with lupus has the antibody, a positive ANA result doesn’t necessarily mean that you have lupus. On the flip side, a negative result doesn’t necessarily mean that youdon’thave lupus.
This article explains what ANA-negative lupus means, how common it is, and the possible reasons for a negative ANA result.
Systemic lupus erythematosus (lupus) is a chronic (long-lasting)autoimmunedisease that can affect many parts of the body.
Lupus can directly cause, among other things:
Symptoms of Lupus
How Lupus Is Diagnosed
No single test can diagnose lupus, and it often takes time to reach a definitive diagnosis. The diagnosis starts with a review of your medical history and family history, a physical exam, and the antinuclear antibody (ANA) test.
A positive result from an ANA test (meaning that the antibody was detected in your blood) is strongly suggestive of lupus. But since ANA is also found in autoimmune diseases likerheumatoid arthritisandscleroderma, it doesn’t necessarily mean that you have lupus.
To confirm the diagnosis, another test—called a multianalyte panel (MAP) of autoantibodies—would be performed to help distinguish it from other autoimmune diseases. On its own, a MAP test (known commercially as AVISE Lupus) is 80% accurate in correctly diagnosing lupus.
Other blood and urine tests would be performed to diagnose conditions associated with lupus (like low blood counts and kidney dysfunction). In their entirety, these findings can help support the diagnosis.
On the flip side, a negative result from an ANA (meaning that the antibody wasnotdetected in your blood) usually rules out lupus as a cause. But not always, according to some experts.
What Is ANA-Negative Lupus?
The ANA test is interpreted based on the antibody titers (or the concentration of the antibodies in a sample of blood). The titer is reported in the ratios like 1:40, 1:60, 1:80, 1:160, 1:320, and 1:640.
Generally, anything under 1:80 is considered negative.
With that said, it is possible for a person to have a low-titer ANA result and still have symptoms consistent with lupus. This is referred to as ANA-negative lupus.
Debating ANA-Negative Lupus
While some people regard ANA-negative lupus as a category of SLE, others (including the ACR) have resisted classifying it as such. In such instances, the spectrum of symptoms may be referred to as:
On one side of the fence, the ACR reports that between 99.3% and 99.6% of people with lupus have a positive ANA test. While the organization acknowledges that some people with lupus-like symptoms have negative ANA results, they argue that the phenomenon needs further research to determine if lupus or some other condition (or overlapping conditions) are involved.
On the other side of the fence, many experts argue that there has yet to be any testing method that is 100% accurate for lupus, including the ANA test.
Moreover, they contend that the vast majority of studies have identified people who fall under the umbrella of ANA-negative lupus, the vast majority of whom do not get treatment because the current criteria exclude lupus as a cause.
TakeawayIn short, the medical community cannot agree as to whether ANA-negative lupus truly exists as a medical condition. Most use it as a way to explain an illness that mimics lupus (or may be lupus) but can’t unequivocally be diagnosed as lupus.
Takeaway
In short, the medical community cannot agree as to whether ANA-negative lupus truly exists as a medical condition. Most use it as a way to explain an illness that mimics lupus (or may be lupus) but can’t unequivocally be diagnosed as lupus.
Summary
ANA-negative lupus is a rare condition in which a person has lupus-like symptoms but test results are negative for an antibody found in almost all people with lupus (called antinuclear antibody or ANA).
Some studies suggest that up to 2% of lupus cases are ANA-negative. Even so, health authorities have resisted classifying it as a subcategory until further research determines whether lupus is the cause or if is due to unrelated, overlapping disorders.
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7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institute of Arthritis and Musculoskeletal and Skin Diseases.Systemic lupus erythematosus (lupus).Centers for Disease Control and Prevention.Lupus basics.Putterman C, Furie R, Ramsey-Goldman R, et al.Cell-bound complement activation products in systemic lupus erythematosus: Comparison with anti-double-stranded DNA and standard complement measurements.Lupus Sci Med .2014;1(1):e000056. doi:10.1136/lupus-2014-000056MedlinePlus.Antinuclear antibody panel.Aringer M, Costenbader KH, Daikh DI, et al.2019 EULAR/ACR classification criteria for systemic lupus erythematosus.Arthritis Rheumatol.2019 Sep;71(9):1400–1412. doi:10.1002/art.40930Li H, Zheng Y, Chen L, Lin S.Antinuclear antibody-negative systemic lupus erythematosus: How many patients and how to identify?Arch Rheumatol.2022 Dec;37(4):626–634. doi:10.46497/ArchRheumatol.2022.9366Lockshin MD, Crow MK, Barbhaiya M.When a diagnosis has no name: Uncertainty and opportunity.ACR Open Rheumatol.2022 Mar;4(3):197-201. doi:10.1002/acr2.11368Additional ReadingL.S. Cross, A. Aslam, S.A. Misbah,Antinuclear antibody-negative lupus as a distinct diagnostic entity—does it no longer exist?QJM: An International Journal of Medicine.2004;97(5):303-308. doi:10.1093/qjmed/hch048The Johns Hopkins Arthritis Center.ANA negative lupus.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institute of Arthritis and Musculoskeletal and Skin Diseases.Systemic lupus erythematosus (lupus).Centers for Disease Control and Prevention.Lupus basics.Putterman C, Furie R, Ramsey-Goldman R, et al.Cell-bound complement activation products in systemic lupus erythematosus: Comparison with anti-double-stranded DNA and standard complement measurements.Lupus Sci Med .2014;1(1):e000056. doi:10.1136/lupus-2014-000056MedlinePlus.Antinuclear antibody panel.Aringer M, Costenbader KH, Daikh DI, et al.2019 EULAR/ACR classification criteria for systemic lupus erythematosus.Arthritis Rheumatol.2019 Sep;71(9):1400–1412. doi:10.1002/art.40930Li H, Zheng Y, Chen L, Lin S.Antinuclear antibody-negative systemic lupus erythematosus: How many patients and how to identify?Arch Rheumatol.2022 Dec;37(4):626–634. doi:10.46497/ArchRheumatol.2022.9366Lockshin MD, Crow MK, Barbhaiya M.When a diagnosis has no name: Uncertainty and opportunity.ACR Open Rheumatol.2022 Mar;4(3):197-201. doi:10.1002/acr2.11368Additional ReadingL.S. Cross, A. Aslam, S.A. Misbah,Antinuclear antibody-negative lupus as a distinct diagnostic entity—does it no longer exist?QJM: An International Journal of Medicine.2004;97(5):303-308. doi:10.1093/qjmed/hch048The Johns Hopkins Arthritis Center.ANA negative lupus.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Institute of Arthritis and Musculoskeletal and Skin Diseases.Systemic lupus erythematosus (lupus).Centers for Disease Control and Prevention.Lupus basics.Putterman C, Furie R, Ramsey-Goldman R, et al.Cell-bound complement activation products in systemic lupus erythematosus: Comparison with anti-double-stranded DNA and standard complement measurements.Lupus Sci Med .2014;1(1):e000056. doi:10.1136/lupus-2014-000056MedlinePlus.Antinuclear antibody panel.Aringer M, Costenbader KH, Daikh DI, et al.2019 EULAR/ACR classification criteria for systemic lupus erythematosus.Arthritis Rheumatol.2019 Sep;71(9):1400–1412. doi:10.1002/art.40930Li H, Zheng Y, Chen L, Lin S.Antinuclear antibody-negative systemic lupus erythematosus: How many patients and how to identify?Arch Rheumatol.2022 Dec;37(4):626–634. doi:10.46497/ArchRheumatol.2022.9366Lockshin MD, Crow MK, Barbhaiya M.When a diagnosis has no name: Uncertainty and opportunity.ACR Open Rheumatol.2022 Mar;4(3):197-201. doi:10.1002/acr2.11368
National Institute of Arthritis and Musculoskeletal and Skin Diseases.Systemic lupus erythematosus (lupus).
Centers for Disease Control and Prevention.Lupus basics.
Putterman C, Furie R, Ramsey-Goldman R, et al.Cell-bound complement activation products in systemic lupus erythematosus: Comparison with anti-double-stranded DNA and standard complement measurements.Lupus Sci Med .2014;1(1):e000056. doi:10.1136/lupus-2014-000056
MedlinePlus.Antinuclear antibody panel.
Aringer M, Costenbader KH, Daikh DI, et al.2019 EULAR/ACR classification criteria for systemic lupus erythematosus.Arthritis Rheumatol.2019 Sep;71(9):1400–1412. doi:10.1002/art.40930
Li H, Zheng Y, Chen L, Lin S.Antinuclear antibody-negative systemic lupus erythematosus: How many patients and how to identify?Arch Rheumatol.2022 Dec;37(4):626–634. doi:10.46497/ArchRheumatol.2022.9366
Lockshin MD, Crow MK, Barbhaiya M.When a diagnosis has no name: Uncertainty and opportunity.ACR Open Rheumatol.2022 Mar;4(3):197-201. doi:10.1002/acr2.11368
L.S. Cross, A. Aslam, S.A. Misbah,Antinuclear antibody-negative lupus as a distinct diagnostic entity—does it no longer exist?QJM: An International Journal of Medicine.2004;97(5):303-308. doi:10.1093/qjmed/hch048The Johns Hopkins Arthritis Center.ANA negative lupus.
L.S. Cross, A. Aslam, S.A. Misbah,Antinuclear antibody-negative lupus as a distinct diagnostic entity—does it no longer exist?QJM: An International Journal of Medicine.2004;97(5):303-308. doi:10.1093/qjmed/hch048
The Johns Hopkins Arthritis Center.ANA negative lupus.
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