Background: The diagnosis of systemic autoimmune diseases (SAID) is challenging, due to overlapping features with other non-immune disorders. Antinuclear antibodies (ANA) /anti-cellular antibodies are the sensitive screening tests but anti-double-stranded-deoxyribonucleic acid-antibody (anti-ds-DNA), and ANA-speci c antibodies are speci c for SAID. We aimed to look at ANA-speci c antibodies in our patients and correlated them with ANA patterns, anti-ds-DNA, and clinical diagnosis for proper interpretation and better patient management cost-effectively.Methods: A retrospective data analysis of 641 patients was done (1st February 2019 to 31st -July-2021) who were tested for ANA-speci c antibodies at

Background:The diagnosis of autoimmune diseases (AID) is challenging, due to overlapping features with other non-immune disorders. Anti-nuclear antibodies (ANA) /anti-cellular antibodies are the sensitive screening tests but anti-double-stranded-deoxyribonucleic-acid-antibody (anti-ds-DNA), and anti-extractable nuclear antigens (anti-ENA) are specific for AIDs. We aimed to look at anti-ENA in our patients and correlated them with ANA patterns, anti-ds-DNA and clinical diagnosis for proper interpretation and better patient management cost-effectively. Methods:A retrospective data analysis of 654 patients was done (1st-February-2019 to 31st –July-2021) who were tested for anti-ENA at the Immunology Department of Indus Hospital and Health Network. ANA and anti-ds-DNA results and clinical diagnosis were also analyzed for anti-ENA-positive patients. The statistical analysis was performed using IBM SPSS 24.0, P < 0.05.was considered statistically significant.Results:Anti-ENA was positive for at least one autoantibody in 245 (38.2%). ANA was positive in 97% of these patients (P=0.000) with speckled and homogenous as most predominant ANA patterns (63% and 33% respectively). Anti-SSA was the most common anti-ENA (n=50%) followed by anti-histones (23%), anti-Sm/RNP (26%), anti-nucleosome (22%). Among ANA-negative patients, anti-SSA was most common (n=5). Anti-ds-DNA was found in 66% of SLE patients. 14% of patients did not have a confirmed diagnosis before anti-ENA testing.Conclusions: Anti-ENA, ANA, and anti-ds-DNA antibodies are essential for AID diagnosis. However, their testing repertoire should follow an algorithm comprising of clinical features, followed by ANA results with nuclear, mitotic, and cytoplasmic patterns, anti-ENA, and anti-ds-DNA for a more meaningful, and cost-effective diagnostic approach.

Background: The diagnosis of systemic autoimmune diseases (SAID) is challenging, due to overlapping features with other non-immune disorders. Anti-nuclear antibodies (ANA) /anti-cellular antibodies are the sensitive screening tests but anti-double-stranded-deoxyribonucleic acid-antibody (anti-ds-DNA), and ANA-specific antibodies are specific for SAID. We aimed to look at ANA-specific antibodies in our patients and correlated them with ANA patterns, anti-ds-DNA, and clinical diagnosis for proper interpretation and better patient management cost-effectively. Methods: A retrospective data analysis of 641 patients was done (1st February 2019 to 31st –July-2021) who were tested for ANA-specific antibodies at the Immunology Department of Indus Hospital and Health Network. ANA and anti-ds-DNA results and clinical diagnosis were also analyzed for ANA-specific antibodies-positive patients. Descriptive data were presented in mean ±standard deviation and frequency percentages whereas inferential data were analyzed with a chi-square test for association between ANA-specific antibodies status, ANA, anti-ds-DNA, and clinical features. Results: ANA-specific antibodies test revealed positivity for at least one autoantibody in 245 (38.2%) patients. Of these, ANA was tested in 206 patients reactive for ANA-specific antibodies and found positive in 195 (95%) as compared to negative (<0.001). Speckled and homogenous were predominant ANA patterns in ANA-specific antibodies-positives (56% and 42% respectively). Multiple ANA patterns were found in 18 patients most commonly with systemic lupus erythematosus (SLE) and mixed connective tissue disorder (MCTD). Anti-SSA were the most common ANA-specific antibodies (50%) and was mostly found in sera with speckled (61/97) and homogenous (38/97) patterns and associated mostly with SLE (48%) and Sjogren’s syndrome (86%). Among ANA-negative patients, anti-SSA were the most common antibodies (n=5). Anti-ds-DNA was found in 66% of SLE patients along with another ANA-specific antibody. Conclusions: This study showed that testing for ANA-specific antibodies cannot be gated on ANA patterns. Also, there is a redundancy of these antibodies with various clinical diagnoses. Moreover, they are useful in making a diagnosis in ANA-negative patients as well with clinical suspicion.