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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)