Likelihood ratios for a positive ANA test have been established for several rheumatic conditions. Step 2: Decide whether to order the test based on which systemic rheumatic disease you suspect and the pre-test probability of that diagnosis None of the above: autoimmune hepatitis, thyroid disease, fibromyalgia, or another condition Rheumatoid arthritis (RA): inflammatory polyarthritis, ulcers or rheumatoid nodules, lung disease Mixed connective tissue disease (MCTD): features of SLE, systemic sclerosis and/or polymyositis swollen hands Raynaud’s phenomenon is often an initial presenting symptom Polymyositis or dermatomyositis: muscle weakness, polyarthralgias, heliotrope rash (purple discoloration of eyes, periorbital edema), mechanic’s hands Systemic lupus erythematosus (SLE): polyarthritis/arthralgia, butterfly rash, photosensitivity, renal dysfunction, drug exposure - hydralazine, minocycline, anti-tumor necrosis factor (anti-TNF), procainamide Systemic sclerosis: sclerodactyly, Raynaud’s phenomenon, telangiectasias, esophageal dysmotility, lung disease, renal dysfunction Diagnostic criteria for connective tissue diseases are often helpful in creating a differential diagnosis in this situation. Before ordering an ANA test, consider whether the patient you are evaluating has groups of features that might guide you toward a particular diagnosis. When a history and examination findings raise clinical suspicion for one or more rheumatic disease, serologic testing can then increase or decrease the pre-test probability of the disease. Approach to deciding whether to order an antinuclear antibody test Step 1: Which systemic rheumatic process do you suspect?
Understand whether the test will be useful in that particular context
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