I was dx'd without a positive ANA, I had several symptoms that would improve with steriod treatment and a terrible butterfly rash. They took me off steriods and did a biopsy of the rash which came out positive. My doctor said many Lupus sufferers will eventually develop a positive ANA and started me back on steriods, hydroxychloroquine, diclofinec and quinacrine. I count my blessings to have had a great team of doctors.
All my symptoms started after snow skiing for two days in the bright sunshine, which, from what I understand, is how the disease is triggered for some.