Anti-nuclear Antibody Testing in Children: How Much Is It Really Necessary?

Haslak, Fatih; Yildiz, Mehmet; Altun, Ilayda; Yilmaz, Gizem; Adrovic, Amra; Sahin, Sezgin; Koker, Oya; Aliyeva, Ayten; Barut, Kenan; Kasapcopur, Ozgur

BACKGROUND In the pediatric age, anti-nuclear antibody (ANA) testing is most commonly ordered by general pediatricians to evaluate children with musculoskeletal system complaints. Given the limited utility of the test, we aimed to estimate the effectivity of ordering ANA testing in childhood. METHODS Children referred to our department to be examined due to ANA positivity between 2008 and 2020 were included in the study. Those with less than one-year follow-up period, those with previously known rheumatic or autoimmune disease, and those diagnosed as an autoimmune and/or rheumatic disease at the first visit were excluded. Data were obtained from their medical records, retrospectively. The parents of all of the patients were called via phone, data were verified, and missing information was collected. RESULTS Three hundred and fifty-eight patients (230 females) were eligible for the study. The median age at ANA positivity was found is 9.31 (1.3-17.86) years old and the median follow-up duration was 4.85 (1-11.91) years. Most of the patients had no underlying disease (n=337, 94.1%). The most common reason for ordering ANA testing was to evaluate musculoskeletal system symptoms (n=225, 62.8%). None of our patients referred to us due to ANA positivity developed any autoimmune conditions or ANA associated rheumatic disease. Hypermobility syndrome is the most common final diagnosis among our ANA-positive patients CONCLUSION: We suggest that instead of using it as a screening tool, ANA testing should be performed if only there is a strong suspicion of autoimmune diseases or certain rheumatic conditions such as systemic lupus erythematosus.