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Molly from Portland asks: In regards to Lupus, I was interested in learning about the connection between how high an ANA titer was and disease activity and/or severity. Is there any way someone with a low titre could have more activity and/or more severe signs and symptoms than someone with a higher titre?

In 2013, most patients who have systemic lupus must be ANA positive. Conversely, a negative ANA essentially rules out a diagnosis of systemic lupus. However, an ANA test is not typically used to follow disease activity. Therefore, a higher titre does not correlate well with disease activity. Other investigations, including markers of inflammation, complement levels, and other antibodies correlate better, but even then, it is not a perfect tool.