Antinuclear Antibody Testing: A Study of Clinical Utility

doi:10.1001/archinte.1996.00440120079007

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Vol. 156 No. 13, 8 JULY 1996

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Antinuclear Antibody Testing

A Study of Clinical Utility

Cindi A. Slater, MD; Roger B. Davis, ScD; Robert H. Shmerling, MD

Arch Intern Med. 1996;156(13):1421-1425.

Abstract

Objective
To determine the clinical utility of the antinuclear antibody(ANA) test as ordered in a large teaching hospital.

Methods
Retrospective chart review in a 400-bed teaching hospital thatprovides care for hospital-based and community-based practices.

Patients
A consecutive sample of 1010 patients (including inpatientsand outpatients) for whom ANA testing was ordered over 10 months;all patients with positive ANA test results and an equal numberof randomly selected patients with negative test results wereincluded. Clinical utility of the ANA in the identificationof rheumatic disease was determined by its estimated sensitivity,specificity, and positive and negative predictive values.

Results
Of 1010 ANA test results reviewed, 153 were positive. The groupwith positive ANA test results included more patients aged 65years or older than the group with negative ANA test results(30% vs 15%, P<.003). The diagnosis of systemic lupus erythematosus(SLE) was established in 17 patients, all of whom had positiveANA test results. Other rheumatic diseases were found in anadditional 22 patients. The estimated sensitivity and specificityof the ANA test for SLE were 100% and 86%, respectively. Forother rheumatic diseases, sensitivity and specificity were 42%and 85%, respectively. The positive predictive value of theANA test was 11% for SLE and 11% for other rheumatic diseases.Specificity and positive predictive value for ANA testing inthe elderly patients were lower than among younger patients.

Conclusions
The sensitivity of the ANA test for SLE was high, but overallthe positive predictive value was low for SLE or other rheumaticdiseases. Sensitivity was low for ANA testing among patientswith non—SLE rheumatic disease. More selective test orderingmight improve the clinical utility of this test. Cliniciansordering the ANA test should be aware of the test's low-positivepredictive value in settings with a low prevalence of rheumaticdisease, particularly among older patients.

Arch Intern Med. 1996;156:1421-1425

Author Affiliations

From the Division of Rheumatology (Drs Slater and Shmerling), Division of General Medicine and Primary Care (Drs Davis and Shmerling) Beth Israel Hospital; Division of Rheumatology, Brigham and Women's Hospital (Dr Slater); and Harvard Medical School (Drs Slater, Davis, and Shmerling), Boston, Mass.

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