Choosing Wisely:

Don’t test antinuclear antibodies (ANA) subserologies without a positive ANA and clinical suspicion of immune-mediated disease.

Rationale and Comments: Tests for ANA subserologies (including antibodies to double-stranded DNA, Smith, RNP, SSA, SSB, Scl-70, centromere) are usually negative if the ANA is negative. Exceptions include anti-Jo1, which can be positive in some forms of myositis, or occasionally, anti-SSA, in the setting of lupus or Sjögren syndrome. Broad testing of autoantibodies should be avoided; instead, the choice of autoantibodies should be guided by the specific disease under consideration.
Sponsoring Organizations:
  • American College of Rheumatology
  • Sources:
  • American College of Rheumatology guidelines
  • Disciplines:
  • Rheumatologic
  • References: • Kavanaugh A, et al. Guidelines for clinical use of the antinuclear antibody test and tests for specific autoantibodies to nuclear antigens. Arch Pathol Lab Med. 2000;124(1):71-81.
    • Solomon DH, et al. Evidence-based guidelines for the use of immunologic tests: antinuclear antibody testing. Arthritis Rheum. 2002;47(4):434-44.
    • Tozzoli R, et al. Guidelines for the laboratory use of autoantibody tests in the diagnosis and monitoring of autoimmune rheumatic diseases. Am J Clin Pathol. 2002;117(2):316-24.

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