{"id":17647,"date":"2023-12-04T13:14:23","date_gmt":"2023-12-04T13:14:23","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=17647"},"modified":"2026-07-30T12:07:52","modified_gmt":"2026-07-30T11:07:52","slug":"immunology-testing-2","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/immunology-testing-2\/","title":{"rendered":"Immunology testing"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>A number of immunology tests are available to GPs. A positive test is significant only if the individual has symptoms.<\/strong><\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"658\" height=\"145\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Immunology-testing.png\" alt=\"Immunology testing\" class=\"wp-image-17648\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Immunology-testing.png 658w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Immunology-testing-300x66.png 300w\" sizes=\"auto, (max-width: 658px) 100vw, 658px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n<style>.kb-table-container17647_9b8ab2-e5{overflow-x:auto;}.kb-table-container .kb-table17647_9b8ab2-e5 th{font-weight:bold;padding-top:var(--global-kb-spacing-xxs, 0.5rem);padding-right:var(--global-kb-spacing-xxs, 0.5rem);padding-bottom:var(--global-kb-spacing-xxs, 0.5rem);padding-left:var(--global-kb-spacing-xxs, 0.5rem);text-align:center;}.kb-table-container .kb-table17647_9b8ab2-e5 caption{text-align:center;}.kb-table-container .kb-table17647_9b8ab2-e5 td{padding-top:var(--global-kb-spacing-xxs, 0.5rem);padding-right:var(--global-kb-spacing-xxs, 0.5rem);padding-bottom:var(--global-kb-spacing-xxs, 0.5rem);padding-left:var(--global-kb-spacing-xxs, 0.5rem);text-align:left;}.kb-table-container .kb-table17647_9b8ab2-e5 tr:nth-of-type(odd){background-color:#E6EDF1;}.kb-table-container .kb-table17647_9b8ab2-e5 td, .kb-table17647_9b8ab2-e5 th{border-top:1px solid #323031;border-right:1px solid #323031;border-bottom:1px solid #323031;border-left:1px solid #323031;}@media all and (max-width: 1024px){.kb-table-container .kb-table17647_9b8ab2-e5 td, .kb-table17647_9b8ab2-e5 th{border-top:1px solid #323031;border-right:1px solid #323031;border-bottom:1px solid #323031;border-left:1px solid #323031;}}@media all and (max-width: 767px){.kb-table-container .kb-table17647_9b8ab2-e5 td, .kb-table17647_9b8ab2-e5 th{border-top:1px solid #323031;border-right:1px solid #323031;border-bottom:1px solid #323031;border-left:1px solid #323031;}}<\/style><div class=\"kb-table-container kb-table-container17647_9b8ab2-e5 wp-block-kadence-table\"><table class=\"kb-table kb-table17647_9b8ab2-e5\">\n<tr class=\"kb-table-row kb-table-row17647_52b393-26\">\n<th  scope=\"col\" class=\"kb-table-data kb-table-data17647_73039d-9f\">\n\n<p class=\"wp-block-paragraph\">Symptoms<\/p>\n\n<\/th>\n\n<th  scope=\"col\" class=\"kb-table-data kb-table-data17647_57624e-36\">\n\n<p class=\"wp-block-paragraph\">Tests to consider doing<\/p>\n\n<\/th>\n\n<th  scope=\"col\" class=\"kb-table-data kb-table-data17647_24fed9-e1\">\n\n<p class=\"wp-block-paragraph\">Likely Rheumatic Condition<\/p>\n\n<\/th>\n\n<th  scope=\"col\" class=\"kb-table-data kb-table-data17647_bd39c6-ab\">\n\n<p class=\"wp-block-paragraph\">Comment<\/p>\n\n<\/th>\n<\/tr>\n\n<tr class=\"kb-table-row kb-table-row17647_3fd962-12\">\n<td  class=\"kb-table-data kb-table-data17647_2a6159-43\">\n\n<p class=\"wp-block-paragraph\">Inflammatory joint symptoms<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>pain,<\/li>\n\n\n\n<li>joint swelling,<\/li>\n\n\n\n<li>significant morning stiffness (&gt;30-45min)<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_3f2b58-9e\">\n\n<p class=\"wp-block-paragraph\">CCP<\/p>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_028159-79\">\n\n<p class=\"wp-block-paragraph\">Rheumatoid arthritis<br>(RA)<\/p>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_a7997f-d9\">\n\n<ul class=\"wp-block-list\">\n<li>A positive CCP may be observed in healthy individuals without joint symptoms. It is not a diagnostic test for RA<\/li>\n\n\n\n<li>A negative CCP does not exclude RA<\/li>\n<\/ul>\n\n<\/td>\n<\/tr>\n\n<tr class=\"kb-table-row kb-table-row17647_253b0b-85\">\n<td  class=\"kb-table-data kb-table-data17647_009e4d-d1\">\n\n<ul class=\"wp-block-list\">\n<li>Sicca symptoms<\/li>\n\n\n\n<li>arthralgia\/arthritis<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_d32be1-99\">\n\n<p class=\"wp-block-paragraph\">ENA<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Rheumatoid factor<\/p>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_7396d1-6f\">\n\n<p class=\"wp-block-paragraph\">Sjogren\u2019s Syndrome<\/p>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_3e6e1b-92\">\n\n<p class=\"wp-block-paragraph\">Antibodies to Ro and La often observed in Sjogren\u2019s<\/p>\n\n<\/td>\n<\/tr>\n\n<tr class=\"kb-table-row kb-table-row17647_0e6f89-72\">\n<td  class=\"kb-table-data kb-table-data17647_6216c6-f5\">\n\n<ul class=\"wp-block-list\">\n<li>Muscle weakness<\/li>\n\n\n\n<li>Raised CK<\/li>\n\n\n\n<li>Swallowing difficulty<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_e5b933-ee\">\n\n<p class=\"wp-block-paragraph\">ANA <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">ENA<\/p>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_dbdc4c-4e\">\n\n<p class=\"wp-block-paragraph\">Dermatomyositis \/ polymyositis<\/p>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_53b01c-c1\">\n\n<ul class=\"wp-block-list\">\n<li>Inflammatory markers usually raised<\/li>\n\n\n\n<li>Significant CK rise( see myositis page)<\/li>\n<\/ul>\n\n<\/td>\n<\/tr>\n\n<tr class=\"kb-table-row kb-table-row17647_5264a7-ec\">\n<td  class=\"kb-table-data kb-table-data17647_5fb3c6-fb\">\n\n<ul class=\"wp-block-list\">\n<li>Arthritis\/arthralgia<\/li>\n\n\n\n<li>Photosensitivity<\/li>\n\n\n\n<li>Malar rash<\/li>\n\n\n\n<li>Mouth ulcers<\/li>\n\n\n\n<li>Hair loss<\/li>\n\n\n\n<li>Pleuritic chest pain<\/li>\n\n\n\n<li>Cytopenias<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_ab24a4-be\">\n\n<p class=\"wp-block-paragraph\">ANA<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">ENA<\/p>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_2957f1-ec\">\n\n<p class=\"wp-block-paragraph\">Lupus<\/p>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_9b9e2b-d6\">\n\n<ul class=\"wp-block-list\">\n<li>A positive ANA can be seen in 30% of healthy people and is not diagnostic of SLE or other CTD.<\/li>\n\n\n\n<li>ANA should not be used to as a screening tool.<\/li>\n<\/ul>\n\n<\/td>\n<\/tr>\n\n<tr class=\"kb-table-row kb-table-row17647_fd2b51-de\">\n<td  class=\"kb-table-data kb-table-data17647_8ee4aa-cf\">\n\n<ul class=\"wp-block-list\">\n<li>Secondary Raynaud\u2019s&nbsp;<\/li>\n\n\n\n<li>Dyspnoea (ILD)<\/li>\n\n\n\n<li>Sclerodactyly<\/li>\n\n\n\n<li>Heartburn<\/li>\n\n\n\n<li>Telangiectasia<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_b04ee9-2f\">\n\n<p class=\"wp-block-paragraph\">ENA<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">ANA<\/p>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_cf547c-2e\">\n\n<p class=\"wp-block-paragraph\">Systemic Sclerosis<\/p>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_135e02-28\">\n\n<p class=\"wp-block-paragraph\">Inflammatory markers often normal<\/p>\n\n<\/td>\n<\/tr>\n\n<tr class=\"kb-table-row kb-table-row17647_65563e-2e\">\n<td  class=\"kb-table-data kb-table-data17647_687a40-36\">\n\n<ul class=\"wp-block-list\">\n<li>Recurrent unexplained miscarriages<\/li>\n\n\n\n<li>unexplained thromboembolic events<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_222b9b-62\">\n\n<p class=\"wp-block-paragraph\">Lupus anticoagulant &amp; anticardiolipin antibodies<\/p>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_489f45-be\">\n\n<p class=\"wp-block-paragraph\">Antiphospholipid syndrome<\/p>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_22de76-bf\">\n\n<p class=\"wp-block-paragraph\">Haematology<\/p>\n\n<\/td>\n<\/tr>\n\n<tr class=\"kb-table-row kb-table-row17647_9cae67-8e\">\n<td  class=\"kb-table-data kb-table-data17647_116555-41\">\n\n<ul class=\"wp-block-list\">\n<li>Generally unwell<\/li>\n\n\n\n<li>Purpuric rash<\/li>\n\n\n\n<li>Proteinuria<\/li>\n\n\n\n<li>unexplained respiratory<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_34e78c-13\">\n\n<p class=\"wp-block-paragraph\">ANCA<\/p>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_8262b9-3e\">\n\n<p class=\"wp-block-paragraph\">Systemic Vasculitis<\/p>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data17647_35c9de-69\">\n\n<p class=\"wp-block-paragraph\">Inflammatory markers raised<\/p>\n\n<\/td>\n<\/tr>\n<\/table><\/div>\n\n\n<p class=\"wp-block-paragraph\"><strong>M.A &amp; H.B\/S.R 29-7-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">Antibody testing should not be used as a screening test for rheumatological disorders. A good history will guide the tests undertaken. These conditions are managed by various specialities and symptoms\/signs will also direct referral.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Only patients who have symptoms suggestive of an autoimmune inflammatory disorder<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If patient has clinical symptoms of an inflammatory arthritis, please refer straightaway instead of waiting for immunology<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">A patient with a positive ANA without symptoms should <strong>NOT<\/strong> be referred to Rheumatology<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>SCI Gateway &gt; Rheumatology &gt; WGH<\/li>\n\n\n\n<li>If patient is systemically unwell with suspected lupus, myositis, vasculitis please discuss with the Rheumatology oncall team<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/\" target=\"_blank\" rel=\"noreferrer noopener\">Rheumatology RefHelp pages<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>A number of immunology tests are available to GPs. A positive test is significant only if the individual has symptoms. M.A &amp; H.B\/S.R 29-7-26<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":4395,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[1051],"class_list":["post-17647","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-immunology-testing-2"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/rheumatology\/https-apps-nhslothian-scot-refhelp-immunology-testing-2\/\" rel=\"tag\">Immunology testing<\/a>","rttpg_excerpt":"A number of immunology tests are available to GPs. A positive test is significant only if the individual has symptoms. M.A &amp; H.B\/S.R 29-7-26","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/17647","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=17647"}],"version-history":[{"count":8,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/17647\/revisions"}],"predecessor-version":[{"id":29279,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/17647\/revisions\/29279"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4395"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=17647"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=17647"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}