How do you approach a negative ANA and positive dsDNA in patients with arthralgia, hair loss, or other UCTD features?  

This could easily be a person with early (evolving) ANA-negative SLE (depending on the dsDNA titer) or early UCTD. If the dsDNA titer is low my concerns are somewhat diminished. I certainly would not assign a diagnosis of SLE given the information provided, with special reference to the person's anx...

I'd start by inquiring with the laboratory about the methodology used for anti-DNA detection and consider a retest. Additionally, I'd conduct a thorough physical examination, paying attention to signs of early synovitis or utilize ultrasounds for further assessment. Considering the possibility of o...

Another important thing to add that is probably not well known:It is essential to ensure that your patient is fasting 8 hours before performing the Crithidia Luciliae anti-dsDNA. LDL cholesterol can artificially increase levels (Kumar et al, PMID 2995252). A non-fasting C. Luciliae anti-dsDNA p...

I agree with Dr. @Sigal. The ANA may have been negative if it was not done by immunofluorescence. What was the level of the anti-DNA? Are there classic features of lupus versus UCTD-MCTD (e.g., skin thickening, marked Raynaud's, etc.)? Does the patient have autoimmune thyroid disease? I have seen th...

Be more meticulous in lab and history review (more necessary diagnostic lab) and just wait and watch. HCQ trial if indicated and patient concurs.