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When your immune system mistakenly produces antibodies that target your own cell nuclei, those antibodies do not all behave the same way. They latch onto different structures inside the cell, and the specific structure they target creates a distinct visual pattern when your blood is tested in the lab. That pattern is your ANA pattern, and it acts like a fingerprint pointing toward particular autoimmune conditions.
A standard ANA test tells you whether your immune system is producing these self-targeting antibodies at all. The ANA pattern tells you something more specific: which proteins or structures inside the cell are under attack. This matters because different targets correspond to different diseases, different organ risks, and different clinical paths.
The test works by placing your blood serum on a slide coated with a specific line of human cells (called HEp-2 cells), then using a fluorescent dye to light up wherever your antibodies have attached. The shape of the glow, whether it fills the entire nucleus uniformly, appears as scattered dots, or clusters around specific structures, is what defines your pattern. The lab also reports a titer, which reflects how concentrated your antibodies are.
The patterns below account for the large majority of positive ANA results. Each one reflects antibodies targeting a different part of the cell, and each points toward a different set of autoimmune conditions. No single pattern is diagnostic on its own, but some carry strong disease associations that guide the next round of testing.
| Pattern | What It Looks Like | Antibody Targets | Primary Disease Associations | Key Details |
|---|---|---|---|---|
| Homogeneous (AC-1) | Smooth, uniform glow across the entire nucleus | Double-stranded DNA, nucleosomes, histones | Lupus (SLE), drug-induced lupus | Most common pattern in lupus (54% in a Swedish registry). Linked to mouth/nasal ulcers, non-scarring hair loss, and immune blood marker abnormalities. |
| Speckled (AC-4/AC-5) | Scattered fine or coarse dots throughout the nucleus | Anti-Ro/SSA, anti-La/SSB, anti-Smith, anti-U1RNP | Lupus, Sjogren syndrome, mixed connective tissue disease, systemic sclerosis | Broadest disease associations of any pattern. Anti-Ro/SSA found in 86% of Sjogren syndrome and 48% of lupus. Anti-Smith is 98% specific for lupus but only 24% sensitive. |
| Centromere (AC-3) | Discrete, evenly spaced dots visible on dividing chromosomes | Centromere proteins, especially CENP-B | Limited cutaneous systemic sclerosis, primary biliary cholangitis, Sjogren syndrome | Over 99% concordance with anti-CENP-B antibodies. Found in about 41% of limited cutaneous systemic sclerosis and 40% of primary biliary cholangitis. |
| Nucleolar (AC-8, AC-9, AC-10) | Bright staining confined to the nucleolus, a small structure inside the nucleus | Fibrillarin, Th/To, PM-Scl, RNA polymerase I and III | Systemic sclerosis (limited and diffuse forms), overlap syndromes with muscle disease | Appears in 5 to 9% of positive ANA tests. The clumpy subtype (AC-9, anti-fibrillarin) signals diffuse systemic sclerosis with worse prognosis. The punctate subtype (AC-10) is linked to diffuse disease with kidney crisis risk. |
| Peripheral/Rim (AC-11) | Bright ring outlining the edge of the nucleus | Nuclear envelope, double-stranded DNA | Lupus, often with aggressive immune features | Associated with the highest anti-dsDNA levels, lowest complement C4, and highest antiphospholipid antibody levels among lupus patients. |
| Dense fine speckled (AC-2) | Fine, dense speckling across the nucleus including on dividing chromosomes | DFS70 protein | Generally argues against autoimmune connective tissue disease when found alone | A reassuring pattern in isolation. Its presence without other autoantibodies makes a connective tissue disease diagnosis unlikely. |
| Topoisomerase I-like (AC-29) | Pattern resembling homogeneous but with distinct features on dividing chromosomes | Topoisomerase I (Scl-70) | Systemic sclerosis | Nearly exclusive to systemic sclerosis. 96.2% of systemic sclerosis patients with this pattern test positive for anti-Scl-70. Typically presents at high titers. |
What this means for you: once you know your pattern, you can have a focused conversation with your clinician about which confirmatory antibody tests to order next. A homogeneous pattern should prompt testing for anti-dsDNA and complement levels. A centromere pattern should prompt evaluation for systemic sclerosis features and liver markers. Your pattern narrows the field.
These patterns are seen less frequently but carry distinct clinical meaning. Cytoplasmic patterns, where the fluorescent glow appears outside the nucleus in the cell's main body, account for roughly 2 to 3.4% of positive ANA tests. Mitotic patterns, visible only when cells are actively dividing, are rarer still.
| Pattern | Antibody Targets | Primary Disease Associations | Key Details |
|---|---|---|---|
| Reticular cytoplasmic (AC-21) | Mitochondria (M2 antigen) | Primary biliary cholangitis, autoimmune liver disease | 66.7% of cases show anti-mitochondrial antibodies. Found in 64% of autoimmune liver disease versus 21.9% of non-autoimmune liver disease. |
| Dense fine speckled cytoplasmic (AC-19) | Nucleosomes, ribosomal P0 protein | Lupus (69.4% of cases with this pattern) | Correlates with anti-nucleosome antibodies (57.7%) and anti-ribosomal P0 (53.8%). |
| Fine speckled cytoplasmic (AC-20) | Synthetase enzymes (Jo-1, PL-7, PL-12) | Inflammatory muscle diseases with lung and joint involvement | May indicate anti-synthetase syndrome, which combines muscle inflammation, lung scarring, and arthritis. |
| Discrete cytoplasmic dots (AC-18) | GW bodies/processing bodies | Sjogren disease, inflammatory muscle disease, malignancy | Notably elevated odds: about 17 times higher for Sjogren disease, 8 times for inflammatory muscle disease, and 5 times for malignancy. |
| Nuclear mitotic apparatus (AC-26) | Proteins active during cell division | No single dominant disease; seen in lupus (28.6%), Sjogren syndrome (11.9%), rheumatoid arthritis (11.9%) | Higher titers show greater enrichment in autoimmune diseases. |
What this means for you: if your report shows a cytoplasmic or rare pattern, it still carries diagnostic value. The reticular cytoplasmic pattern (AC-21) is one of the strongest pointers toward autoimmune liver disease. The discrete cytoplasmic dots pattern (AC-18) is unusual in that it is associated not only with autoimmune conditions but also with malignancy, which may warrant broader clinical evaluation.
Your ANA result includes two pieces of information: the pattern and the titer. The titer is expressed as a ratio (1:40, 1:80, 1:160, and so on) and reflects how diluted your blood can be while still showing a positive result. A higher number means a stronger antibody signal.
Age is the most important confounder to keep in mind before interpreting your titer. Low-titer results (1:40 to 1:80) are common in healthy people: up to 20 to 30% of healthy individuals test positive at these levels, and as many as one-third of healthy adults over age 65 may have a positive ANA. A titer of 1:160 or higher carries substantially more clinical weight.
If your ANA is positive at a low titer with a speckled pattern, the likelihood that it reflects a specific autoimmune disease is much lower than if the same pattern appears at 1:320 or above. Pattern and titer together are more informative than either alone. A positive ANA is an entry point for further testing, not a diagnosis by itself. Certain lab factors can occasionally affect the result, so if a result seems inconsistent with your symptoms, repeat testing is reasonable.