Provider Resources / ANA information

ANA Testing Information

The Rheumatology Department has compiled important and helpful information regarding Antinuclear Antibody (ANA) testing in children. This resource is designed to assist families and healthcare providers in understanding when ANA testing is appropriate, what the results may indicate, and how they relate to pediatric autoimmune conditions.

Download the information about ANA Testing here.

Rheumatology Referral Guidelines

See the referral guidelines below with suggestions on what conditions are non-urgent versus urgent/emergent.

Conditions/symptoms for non/urgent referrals

These are appropriate referrals that will be scheduled at the next open available date/time.

Arthritis: non-systemic

• Non-intermittent joint swelling >6 weeks without trauma
• +/- Elevated inflammatory markers

Generalized purpura (Henoch-Schonlein purpura)

• Consistent symptoms >3 months from onset
• NOT URGENT: symptoms < 3 month

Recurrent fevers

• Episodic occurrence every 1-2 months apart - without associated infections

Positive ANA: not appropriate unless meets following criteria

• >1:320 ANA with associated positive extractable nuclear antigen (ENA) test
• Joint swelling and/or persistent rash

Raynaud’s disease

• Positive ANA >1:320
• Color changes in hands and/or feet
• Rash and joint pain

Fatigue and rash: not appropriate unless meets following criteria

• Symptoms related to juvenile idiopathic arthritis (JIA) or lupus
• Pertinent positive lab result supporting an autoimmune disorder
• Non-itching rash with other associated listed symptoms

Conditions/symptoms for urgent/emergent referrals

The department will review for priority scheduling. Most appointments will be scheduled within 6-8 weeks.

Arthritis: systemic

• +/- Elevated inflammatory markers
• Fine/lacy rash with chronic fever

Muscle weakness

• Elevated CPK and aldolase levels
• Chronic inability to perform ADLs or inability to get up unassisted from sitting position

Uveitis/Iritis

• Eye inflammation - mandatory referral from ophthalmology

Lupus

• Malar rash and/or discoid rash
• Joint pain with swelling
• Non-painful mouth ulcers
• Positive biopsy and chronic fever

Vasculitis: may consult prior to referral

• Purpuric rash and fever
• Joint swelling
• Positive inflammatory markers
• Positive biopsy

Chronic recurrent multifocal osteomyelitis (CRMO)

• Fevers
• Skin rashes
• Elevated inflammatory markers (ESR & CRP)
• Multiple tender areas and swollen joint and bone

Download the guidelines here