American Academy of Pediatrics – Section on Rheumatology
View all recommendations from this societyAugust 6, 2019
Do not order antinuclear antibody (ANA) and other autoantibody testing on a child unless there is strong suspicion or specific signs of autoimmune disease.
The antinuclear antibody (ANA) has a high sensitivity for only one disease, systemic lupus erythematosus (SLE), but has very poor specificity for SLE and every other rheumatic disease. Therefore, it is not useful or indicated as a general screen of autoimmunity.
A positive ANA may occur secondary to polyclonal activation of the immune system following an infection, or it may be positive without any identifiable reason/disease in up to 32% of the population. Limiting patients on which to order ANA would reduce unnecessary physician visits and laboratory expenses as well as parental anxiety. “Lupus panels” and other similar panels should also not be ordered without concerns for specific autoimmune disease. Additionally, since the ANA may always be positive and may fluctuate in titer, it is not recommended to retest it unless there is some new clinical concern.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
The American Academy of Pediatrics’ Section on Rheumatology (SORh) consists of pediatric rheumatologists, pediatricians, and allied health care professionals who are actively involved in some aspect of the study of rheumatologic disease in children and adolescents. The SORh strives to inform pediatricians, parents, communities, and policy makers on rheumatic disease in children. The fellow members of the SORh were queried to develop a list of diagnostic and management decisions that have resulted in misuse of laboratory studies and resources. Through a series of votes, the fellow members developed the list into five statements to address the most common misconceptions seen when encountering pediatric autoimmune conditions. The fellows involved in this project are: Kathleen Collins, Brian Dizon, Suhas Ganguli, Miriah Gillispie, Marla Guzman, Michael B. Nelson, Onengiya Harry, Meiqian Ma, MaiLan Nguyen, Amir Orandi, Amanda Schlefman, Laura Tasan, and Erin Treemarcki. The list was shared with membership of the SORh Executive Committee for feedback and then finalized by collaboration. These five clinical issues are the result. Various expert committees and sections of the AAP reviewed and approved the list. The AAP Executive Committee granted final approval of the list.
AAP’s disclosure and conflict of interest policy can be found at www.aap.org.
Sources
Cabral DA, Petty RE, Fung M, Malleson PN. Persistent Antinuclear Antibodies in Children Without Identifiable Inflammatory Rheumatic or Autoimmune Disease. Pediatrics. 1992;89(3):441-444.
Deane PMG, Liard G, Siegel DM, Baum J. The Outcome of Children Referred to a Pediatric Rheumatology Clinic With a Positive Antinuclear Antibody Test but Without an Autoimmune Disease. Pediatrics. 1995;95(6):892-895.
Hilario MOE, Len CA, Roja SC, Terreri MT, Almeida G, Andrade LEC. Frequency of Antinuclear Antibodies in Healthy Children and Adolescents. Clinical Pediatrics. 2004;43:637-642.
Malleson PN, Sailer M, Mackinnon MJ. Usefulness of antinuclear antibody testing to screen for rheumatic disease. Arch Dis Child. 1997;77:299-304.
