Quick Facts
- Sample: Blood draw (serum); approximately 1 mL required
- Fasting: No fasting required
- Turnaround Time: 2–5 business days. May take longer based on weather, holiday, or lab delays.
Benefits
- Gold-standard methodology — Uses HEp-2 immunofluorescence assay endorsed by the American College of Rheumatology
- Comprehensive screening — Detects over 100 autoantibodies with one blood draw; Lupus Panel 2 adds six disease-specific markers
- Reflex testing included — Positive results automatically quantify titer and identify fluorescence patterns at no extra cost
- No physician referral needed — Order confidently online and visit any convenient lab location during extended hours
- Transparent pricing — Upfront costs with no hidden insurance billing or surprise fees
- Fast, actionable results — Secure online portal delivers findings within one week to inform your healthcare conversations
Who Is This Test For?
- Individuals experiencing unexplained joint pain, fatigue, rashes, or recurring low-grade fevers lasting several weeks
- Those with family history of lupus, Sjögren's syndrome, or other autoimmune conditions seeking baseline screening
- People noticing Raynaud's phenomenon (fingers/toes changing color with cold), persistent dry eyes, or dry mouth
- Anyone with butterfly-shaped facial rash, hair loss, oral ulcers, or photosensitivity needing diagnostic clarity
- Patients with known autoimmune disease monitoring treatment response or tracking disease activity over time
- Women aged 15–44, particularly of Black, Hispanic, Asian, or Native American descent at higher lupus risk
How It Works – Just 3 Steps
- Order online — Purchase your test without physician referral; receive lab requisition within minutes
- Visit the lab — Schedule a blood draw at any participating lab location with your requisition
- Access results — Receive results in your secure online portal within 2–5 days
FAQ
What conditions does this test detect? The ANA Screen, IFA, with Reflex to Titer and Pattern detects antibodies associated with lupus, Sjögren's syndrome, systemic sclerosis, mixed connective tissue disease, and other autoimmune disorders. Lupus Panel 2 adds specific markers for anti-dsDNA, SCL-70, Sm, RNP, SSA, and SSB antibodies, along with ANA titer and pattern analysis, to refine diagnosis.
How accurate is the ANA test? HEp-2 immunofluorescence demonstrates 95–98% sensitivity for systemic lupus erythematosus when using a 1:80 cutoff, meaning it correctly identifies most lupus patients. Specificity ranges 88–96% depending on titer threshold.
Can I have a positive ANA without disease? Yes—approximately 15% of healthy individuals show low-titer ANA positivity, especially women and older adults. Clinical symptoms determine whether further evaluation is needed.
Will medications affect my results? Certain drugs including procainamide, hydralazine, and some anti-epileptics can induce lupus-like conditions with positive ANA. Inform the lab about all medications you take.
What if my ANA is negative but I still have symptoms? Some autoimmune diseases occur with negative ANA (seronegative lupus). Persistent symptoms warrant specialist consultation to explore alternative diagnoses.
Do I need to repeat testing if positive? Generally no—once positive, ANA titers tend to remain stable. Exceptions include significant new symptoms suggesting different autoimmune disease. For known disease monitoring, specific autoantibody levels (particularly anti-dsDNA) better assess activity than ANA titer changes.
More Details
What is the purpose of this test?
The ANA Screen with Reflex detects antinuclear antibodies—immune proteins that mistakenly attack the body's own cells. While a healthy immune system produces antibodies to fight infections, ANAs target nuclear material within your cells, signaling potential autoimmune disease. This test uses indirect immunofluorescence on HEp-2 cells, the American College of Rheumatology's gold-standard method, to screen for antibody presence. Positive results automatically trigger reflex testing that measures antibody concentration (titer from <1:40 to >1:1280) and identifies specific fluorescence patterns (homogeneous, speckled, nucleolar, centromere, peripheral) that guide diagnosis.
Lupus Panel 2 expands this foundation by simultaneously testing six disease-specific autoantibodies: anti-dsDNA (highly specific for lupus and kidney involvement), SCL-70 (systemic sclerosis marker), Sm and Sm/RNP antibodies (lupus and mixed connective tissue disease), and SSA/SSB antibodies (Sjögren's syndrome and lupus). This comprehensive approach captures multiple autoimmune markers in one blood draw, enabling efficient differential diagnosis when symptoms overlap across conditions.
Who would benefit from this test?
This test is ideal for individuals experiencing symptoms suggestive of autoimmune disease. Joint pain with morning stiffness lasting over 30 minutes, persistent unexplained fatigue, skin rashes (especially butterfly-shaped facial rash), recurrent fevers without infection, and Raynaud's phenomenon (color changes in fingers/toes with cold exposure) all warrant ANA screening. Dry eyes or dry mouth requiring frequent intervention, hair loss, oral ulcers, and unexplained weight loss also justify testing.
Those with family history of lupus, Sjögren's syndrome, or related autoimmune conditions benefit from baseline screening, as genetic factors increase risk. Women face nine times higher lupus rates than men, with peak incidence between ages 15–44. Black, Hispanic, Asian, and Native American populations experience 2–3 times higher prevalence and more severe disease (CDC 2021).
Patients with known autoimmune disease use these tests to monitor treatment response and predict disease flares. Rising anti-dsDNA levels correlate with increased lupus activity and kidney involvement risk, making serial testing valuable for disease management.
When should I order this test?
Order this test when unexplained symptoms persist for several weeks despite adequate rest and self-care. Joint stiffness lasting over 30 minutes each morning, extreme fatigue interfering with daily activities, or new skin rashes (particularly on sun-exposed areas) justify immediate screening. Recurrent unexplained fevers, persistent dry eyes or mouth, or Raynaud's phenomenon also warrant testing (Cleveland Clinic).
Timing matters—schedule testing when symptoms are active, as autoantibody levels can fluctuate. Avoid testing immediately after acute infections or vaccinations, which may transiently elevate ANA levels. If you have risk factors including female gender, age 15–44, or high-risk racial/ethnic background, proactive screening enables early detection when treatment is most effective.
For individuals with known autoimmune disease, order testing when new symptoms emerge that suggest disease flare or organ involvement. Increasing joint pain, new rashes, worsening fatigue, or changes in urination patterns may indicate active disease requiring treatment adjustment (Hospital for Special Surgery).
How do I interpret the results?
- <1:40 (Negative): No significant autoantibodies detected; lupus and systemic autoimmune diseases unlikely → Reassurance; explore alternative diagnoses if symptomatic.
- 1:40–1:80 (Low Positive): May occur in 10–15% of healthy individuals; clinical correlation essential → Specialist consultation if symptomatic; monitoring if asymptomatic.
- 1:160–1:640 (Moderate Positive): Increased probability of autoimmune disease; pattern guides specific diagnosis → Rheumatology referral; additional confirmatory testing recommended.
- ≥1:1280 (High Positive): Strong association with active systemic autoimmune disease → Urgent specialist evaluation; comprehensive clinical workup indicated.
Disclaimer: Reference ranges may vary by laboratory. Listed ranges are general guidelines and may differ from those used by the performing lab. Always consult your healthcare provider for interpretation.
Approximately 204,000 Americans have systemic lupus erythematosus, with women accounting for 90% of cases—yet early detection through ANA screening enables timely intervention that significantly improves long-term outcomes (Lupus Research Alliance 2021).
Fluorescence patterns provide additional diagnostic clues. Homogeneous patterns suggest lupus or drug-induced lupus; speckled patterns appear in lupus, Sjögren's, mixed connective tissue disease, and systemic sclerosis; nucleolar patterns indicate systemic sclerosis; centromere patterns associated with limited cutaneous systemic sclerosis (CREST syndrome); peripheral/rimmed patterns are characteristic of lupus.
Specific autoantibody results refine diagnosis further. Anti-dsDNA positivity demonstrates 97–100% specificity for lupus; levels correlate with disease activity and kidney involvement. SCL-70 antibodies suggest systemic sclerosis, particularly diffuse cutaneous forms with lung disease risk. Sm antibodies are highly specific for lupus. SSA/SSB antibodies indicate Sjögren's syndrome or lupus with sicca features.
Pre-test preparation
No fasting is required—eat and drink normally before your appointment. Continue all prescribed medications unless your physician specifically advises otherwise. Inform the laboratory about all medications including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements, as certain drugs (particularly procainamide, hydralazine, isoniazid, and some anti-epileptics) can induce lupus-like conditions with positive ANA.
Maintain adequate hydration before your visit to facilitate blood draw and ensure specimen quality. Wear clothing allowing easy arm access for venipuncture. Inform the phlebotomist of any bleeding disorders, anticoagulant use, or history of fainting during blood draws.
Schedule testing when symptoms are present, as autoantibody levels can fluctuate. Avoid testing immediately after acute infections or recent vaccinations, which may transiently elevate ANA levels and produce misleading results.
How often should I get tested?
- Initial screening for unexplained symptoms: Once; repeat only if the clinical picture changes significantly.
- Known lupus monitoring disease activity: Anti-dsDNA levels every 3–6 months; ANA typically not repeated.
- Borderline positive ANA without diagnosis: Repeat in 6–12 months if new symptoms develop.
- Family history of autoimmune disease (asymptomatic): Baseline once; repeat if symptoms emerge.
- Lupus nephritis screening (known SLE): Urinalysis every 6–12 months per ACR 2024 guidelines.
Once positive, ANA titers tend to remain stable throughout the course of the disease. Repeat ANA testing is generally unnecessary and not recommended unless significant new symptoms suggest a different autoimmune condition. For patients with known disease, specific autoantibody levels (particularly anti-dsDNA) provide better assessment of disease activity than ANA titer changes.
For individuals with systemic lupus erythematosus, the American College of Rheumatology 2024 guidelines strongly recommend screening all patients for proteinuria every 6–12 months to detect kidney involvement early, when intervention is most effective.
Why early detection matters
Approximately 20% of lupus patients develop kidney involvement (lupus nephritis), representing the most serious complication. Early detection through regular screening prevents progression to end-stage renal disease requiring dialysis or transplantation. A 2024 study found that patients with delayed-onset lupus nephritis (diagnosed over one year after SLE diagnosis) exhibited more severe manifestations and worse outcomes, emphasizing the value of ongoing monitoring.
Autoimmune diseases diagnosed early respond better to treatment, with significantly improved long-term outcomes. Early intervention prevents irreversible organ damage, reduces disease severity, and preserves quality of life. The EULAR/ACR 2019 Classification Criteria for Systemic Lupus Erythematosus achieved 96.1% sensitivity and 93.4% specificity in validation studies, demonstrating that accurate early diagnosis is achievable with proper testing.
Black and American Indian/Alaska Native women face 2–3 times higher lupus risk than White women and tend to develop more severe disease. These populations particularly benefit from proactive screening that enables timely diagnosis and intervention before serious complications develop (CDC 2021).
Related tests you may consider
Lupus Autoimmune Blood Test Panel — Provides a comprehensive assessment for lupus and related autoimmune disorders. This panel evaluates inflammation, blood clotting, organ function, and the presence of autoantibodies commonly associated with autoimmune activity. Tests include ANA screening, complement levels, inflammatory markers (ESR and CRP), CBC, CMP, coagulation studies (PT/INR and aPTT), urinalysis, and rheumatoid factor to help identify immune-related abnormalities and assess disease activity.
Cyclic Citrullinated Peptide (CCP) Antibody Blood Test, IgG — Measures antibodies highly specific for rheumatoid arthritis (RA). Approximately 60–80% of RA patients test positive for anti-CCP, making it a valuable marker for early diagnosis and for distinguishing RA from other autoimmune diseases such as lupus.
Thyroid #1 Baseline Blood Test Panel — Measures key hormones involved in thyroid function, including TSH, Total T4, T3 Uptake, and the Free T4 Index (T7). This panel helps evaluate thyroid activity to identify conditions such as hypothyroidism or hyperthyroidism, which can cause fatigue, weight changes, and other symptoms that may overlap with autoimmune disorders like lupus.
