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Table 1 ANA-reflex test procedure with titres ≥1:160 and typical patterns

From: The ANA-reflex test as a model for improving clinical appropriateness in autoimmune diagnostics

ANA-IIF pattern on HEp-2 cells Reflex test(s)
Nuclear homogeneous ≥1:160 Antibodies to intracellular specific antigens (ENA) and to dsDNA/nucleosomes
Nuclear speckled ≥1:160 Anti-dsDNA and antibodies to intracellular specific antigens (ENA), possibly including anti-RNA polymerase III
Nuclear Scl70-like ≥1:160 Antibodies to intracellular specific antigens (ENA) (possibly including anti-PM/Scl)
Cytoplasmic speckled ≥1:160 Antibodies to intracellular specific antigens (ENA), including anti-tRNA synthetases and anti-P ribosomal
Pleomorphic PCNA-like (any titre) Anti-PCNA
Centromere No confirmation necessary if high titres. Execute specific test for anti-CENP B only in dubious cases (low titre or centromeric pattern not clearly recognizable)
  1. ENA includes SS-A/Ro52 and Ro60, SS-B/La, Sm, RNP, Jo-1, and Scl70