Antinuclear antibody (ANA) testing in primary care. The test is positive what now? A two-phase observational study of UK primary care

The ANA-associated diseases are rare autoimmune diseases (including Systemic lupus erythematosus [SLE], Sjögren's, Scleroderma, autoimmune hepatitis). Interpretation of ANA-tests is difficult, it is frequently positive in patients who do not appear to have an associated disease. In those who ar...

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Bibliographic Details
Published in:British journal of general practice 2023-07, Vol.73 (suppl 1), p.bjgp23X733725
Main Authors: Evans, Will, Vinogradova, Yana, Pearce, Fiona, Lanyon, Peter, Kai, Joe, Qureshi, Nadeem
Format: Article
Language:English
Subjects:
Antibodies, Antinuclear
Autoimmune diseases
Case-Control Studies
Cohort Studies
Female
Humans
Lupus
Male
Medical diagnosis
Mortality
Observational studies
Primary care
Primary Health Care
Risk factors
United Kingdom
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Summary:The ANA-associated diseases are rare autoimmune diseases (including Systemic lupus erythematosus [SLE], Sjögren's, Scleroderma, autoimmune hepatitis). Interpretation of ANA-tests is difficult, it is frequently positive in patients who do not appear to have an associated disease. In those who are ANA-positive we suspect there are features that can help distinguish those who will later develop disease. To understand the characteristics of those tested, and in those who have positive features associated with disease development. Two phase study: 1) A case control study to examine characteristics of those tested. Cases defined as having had an ANA-test performed regardless of result, matched to controls who have never had an ANA test. 2) A cohort study of ANA-tested cases. In those who are ANA-positive, exposures (from literature, clinicians, and patients) will be used to predict the outcome ANA-associated disease. 888,179 patients have at least one ANA-test performed: positive 22,587 (2.54%), negative 21,908 (2.47%), unknown 843,684 (94.99%). HR if positive: ANA-disease 5.15 (4.89 to 5.43); All-cause mortality 1.20 (1.16 to 1.24); CV mortality 1.20 (1.14 to 1.27) (adjusted HR (95% CI)). . At 3 years 10.0% (9.7 to 10.5%) and at 20 year 15.7% (16.5 to 14.9% (95% CI) develop ANA-associated disease. HR for Female 2.29 (1.96 to 2.68);
ISSN:0960-1643
1478-5242
DOI:10.3399/bjgp23X733725