Table 2 ANA-reflex test procedure in relation to clinical manifestations
From: The ANA-reflex test as a model for improving clinical appropriateness in autoimmune diagnostics
Clinical manifestation | Reflex test(s) |
|---|---|
Persistent oral or ocular dryness | Anti-intracellular specific antigens (anti-ENA) |
Raynaud’s phenomenon and/or photosensitivity (or malar rash) and/or leucopenia and/or arthritis | Antibodies to dsDNA and to intracellular specific antigens (anti-ENA) |
Raynaud’s phenomenon and ANA positivity with nucleolar pattern at elevated titres (≥1:320) | Anti-PM/Scl, anti-fibrillarin, anti-RNA polymerase III and Th/To |
Significantly increased CPK | Antibodies to intracellular specific antigens (anti-ENA) and myositis-associated antibodies |
ANA positivity (even at a titre 1:80) and persistent arthritis | Anti-citrullinated peptide antibodies and rheumatoid factor |
Positive ANA and/or SLE-associated specific antibodies (dsDNA, Sm, RNP, Ro52, and 60Kd), with a clinical history of thrombotic events and/or polyabortion | Anti-phospholipid antibodies (anti-cardiolipin, anti-beta2 glycoprotein I, lupus anticoagulant) |