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Does the Dense Fine Speckled Pattern in an ANA Test Actually Tell us Anything Important Clinically?

Mia C. Lundgren ; John T. Crosson

Antinuclear Antibody (ANA) testing is used as a screening tool for Systemic Autoimmune Rheumatic Disease (SARD). While most patterns identified have known disease associations, the dense fine speckled (ANA-DFS) pattern has no confirmed clinical correlations. For this reason, the ANA-DFS pattern has generated confusion and frustration for both patient and provider. Previous studies have observed a higher frequency of this pattern in healthy individuals compared to patients with SARD. Additional studies have shown associations with other diseases including, but not limited to, interstitial cystitis, skin disease, thyroid disease, ocular disease, prostate cancer, and fibromyalgia. In our recent retrospective study, the objective was to determine the prevalence of SARD among 425 patients with the ANA-DFS pattern and to determine the prevalence of non-SARD along with possible clinical associations. The prevalence of SARD was 24%, a much higher frequency compared to prior studies. The most common non-SARD were atopic disorders (21.2%), fibromyalgia/chronic pain syndrome/chronic fatigue syndrome (17.6%), and skin disorders (16.7%). Given that over 75% of the patients with the ANA-DFS pattern from our study were noted to have an important inflammatory disorder requiring treatment and that almost 25% had a disorder requiring management by Rheumatology, the ANA-DFS pattern appears to be an indicator of a proinflammatory microenvironment.