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...

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 positi...

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 ot...

I agree with Dr. @Dr. First Last. 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 hav...

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