Prospective Evaluation of Antinuclear Antibody Positivity in Children: Clinical Course and Diagnostic Outcomes

Background: Antinuclear antibody (ANA) testing is widely used in children with non-specific symptoms, yet its clinical relevance remains uncertain due to high positivity rates in healthy individuals.This study aimed to prospectively assess the clinical course and diagnostic outcomes of children referred for ANA positivity, to better inform follow-up strategies.Materials and Methods: Forty-eight ANA-positive pediatric patients without a prior rheumatologic diagnosis and referred to the pediatric rheumatology clinic were prospectively followed for at least two years using a standardized protocol. Results:Of the 48 patients included in the study, 35 (72.9%) were female.The most common referring department was general pediatrics (n=23, 47.9%), followed by pediatric hematology (n=13, 27.1%).The most frequent reason for ANA testing was joint pain (n=14, 29.2%), followed by thrombocytopenia (n=6, 12.5%) and urticaria (n=6, 12.5%).During follow-up, two patients were diagnosed with systemic lupus erythematosus (SLE) and one with juvenile idiopathic arthritis.ANA titers became negative over time in 39.6% of the patients.Among those who did not receive a diagnosis, the median follow-up duration was 34 months (interquartile range: 26.5-50). Conclusion:ANA positivity in children is often transient and clinically insignificant, and management should prioritize clinical context and symptom-guided monitoring rather than routine extensive evaluation.