Should antinuclear antibodies (ANA) be used to screen for connective tissue disease in neurological patients?

Background: Patients with connective tissue diseases (CTD) can have a wide range of neurological manifestations. Neurological complaints may be the presenting symptom of CTD. Therefore, screening for CTD using anti-nuclear antibodies (ANA) is a common practice. However, due to the abundance of positive ANA in a healthy population, interpretation of the results may be complex.

Methods: we retrospectively evaluated files of patients hospitalized for evaluation of neurological symptoms in Sheba Medical Center during the years 2007-2022. Data was collected regarding epidemiology, ANA status, and rheumatological diagnosis.

Results: 4723 patients' files were reviewed. Of them, 46.6 % were positive for ANA. 6.9 % of them were diagnosed with CTD. This population had significantly higher rates of positive ANA status (71.2 % vs 28.8 %, p < 0.001), was significantly older (59.4 vs 53.4 years, p < 0.001) and had a significantly higher ANA titer (1:484.8, 1:268 p < 0.001) compared to patients without CTD. Factors which were found predictive for CTD diagnosis included female gender, older age, ANA titer above 1:160, and the diagnosis of a non-vascular etiology for the neurological disease.

Conclusion: Females, older patients, patients with high ANA titer and with diagnosis of a non-vascular cause to their neurological complains may be more likely to harbor a CTD and should probably be further evaluated.