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To the rheumatologist, the ANA is a double-edged sword. On one hand, it is a simple first-line test with high sensitivity that can help diagnose a variety of autoimmune diseases. On the other hand, when ordered inappropriately, it can cause confusion and unnecessary concern among patients and providers alike. Prior to ordering ANA testing, there must be a high pre-test probability for autoimmune disease.

Dinse et al. have published a captivating study in about the increased prevalence of ANAs in the United States. Is it unclear if participants of this study had any clinical signs or symptoms of autoimmune disease, thus making it difficult to interpret the significance of the positive antibody. The authors describe a variety of environmental stressors that could be leading to this increased trend -- which is concerning as they are not stressors that can be easily modified.

In 2015, the American College of Rheumatology aimed to project the supply and demand for clinical rheumatology care for 2015–2030. An estimated shortage of 3,269 rheumatologists was predicted by 2025. If, in fact, increased positive ANA levels lead to increased autoimmune disease, I fear for the future of this physician community and the unrealistic expectation that higher demand can be met by a workforce whose numbers remain the same.

Patil Injean, DO, is a second year rheumatology fellow at Cedars-Sinai Medical Center in Los Angeles.

Read the study here and a Q&A with a study coauthor here.