The initial manifestations and final diagnosis of patients with high and low titers of antinuclear antibodies after 6 months of follow-up.

BACKGROUND The antinuclear antibody (ANA) test is the most commonly used test to screen for autoimmune diseases. However, only a limited numbers of studies have addressed the characteristics of patients positive for ANA. In this study, we aimed to clarify the relationship between initial presentations, ANA titer, and final diagnoses. METHODS Patients who visited National Taiwan University Hospital and received a first ANA test were enrolled and then followed for a further 6 months. The symptoms and signs at the time of ANA testing, ANA titers, and the final diagnoses were recorded and analyzed. RESULTS A total of 355 patients were positive for ANA. Joint pain was the most common initial presentation at the time of ANA testing. Compared with the patients with low ANA titers (<1:640), those with high ANA titers (≥ 1:640) were more susceptible to autoimmune diseases. More importantly, of the patients with initial presentations of joint pain, fever, abnormal urinalysis, or skin rash/skin tightness, autoimmune diseases were more frequently diagnosed in those with high ANA titers than with low ANA titers (p<0.05). In addition, both anti-double strand DNA antibodies and anti-extractable nuclear antibodies were more commonly detected in patients with high ANA titers. CONCLUSIONS A high ANA titer seems to be a useful biomarker for the diagnosis of autoimmune diseases, especially for patients presenting with joint pain, fever, abnormal urinalysis, or skin rash/skin tightness.