Can a patient with SLE ever be ANA negative

Can a patient with SLE ever be ANA negative?

Yes, but very rarely. Few patients (<1%) with active, untreated SLE will have a negative ANA. These patients usually have one of the following:

• Hereditary early complement component deficiency (C2, C4). These patients usually have low-titer ANAs.

• Have antibodies only to the nuclear antigen SS-A (Ro) and are ANA-negative because:

1. The substrate used in the fluorescent ANA test did not contain sufficient SS-A antigen to allow detection of those antibodies. While such patients are ANA-negative on rodent tissue substrates, they are almost always positive when HEp-2 substrate is used; OR

2. The antibody is only directed against the 52 kDa SS-A/Ro protein, which is located in the cytoplasm and not against the 60 kDa SS-A/Ro protein, which is located in the nucleus.

• A very few cases of SLE may have antibodies restricted to cytoplasmic constituents (e.g., ribosomes, ribosomal P, and others).

• Rarely, SLE patients (up to 10%–15%) will become ANA-negative with treatment and their disease becomes inactive.

• Rarely, SLE patients with severe proteinuria may be ANA-negative due to antibody loss in the proteinuria. ANA becomes positive with decrease in proteinuria with therapy.

• SLE patients with end-stage renal disease on chronic dialysis can become ANA-negative.

• Technical factors and prozone effect can sometimes be responsible for a negative ANA.

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