Is there a minimum work-up necessary in patients with an ANA greater than 1:160 and no clinical symptoms suggestive of lupus (i.e., specific antibodies, UA)?

My personal practice has been to get the "ANA subtypes" and a UA for prot/Cr ratio, but I do this with the idea of needing to have a complete picture. Clinical symptoms are still king.

In addition, I screen for other autoimmune diseases such as autoimmune liver disease and autoimmune thyroid disease. These of course have + ANA. ANA can occur in a variety of other illnesses which are characterized by hypergammaglobulinemia. Look for Sjogren's, sarcoid, lymphoma, hepatitis C to name...