Inappropriate use of commercial Antinuclear Antibody Testing in a community-based US hospital: a retrospective study

Abstract

Healthcare providers use antinuclear antibodies (ANAs) to screen and diagnose patients with autoimmune diseases. In the recent years, commercial multiplex ANA kits have emerged as a convenient and fast diagnostic method. Diagnostic testing should follow sequenced algorithms: initial screen followed by specific antibody analysis. Second-level testing as an initial screen for autoimmune disease is inappropriate. We reviewed 68 patients with ANA comprehensive panels over a 6-month period from May 2015 to October 2015. We assessed appropriateness and estimated incurred losses from inappropriate testing. We found 92.6% (63 out of 68) of the ANA comprehensive panel results to be negative. Incurred losses from inappropriate ANA comprehensive panel testing were $66,000. Physicians should become familiar with ANA-sequenced diagnostic algorithms to avoid unnecessary higher level testing.

Frequency of repeat antinuclear antibody testing in Ontario: a population-based descriptive study

“…Our findings are consistent with previous studies showing that ANA testing is pervasive in rheumatology practice. 22,23,27,28,[30][31][32] We observed similar frequencies of ANA positivity in our sample and similarly identified that family physicians order the majority of ANA tests. 27,31 Although there are far more family physicians than other specialists, it has been suggested that family physicians have limited expertise in interpreting ANA tests and may ignore results.…”

Reliability and reproducibility of antinuclear antibody testing in pediatric rheumatology practice

“…Multiplex immunoassays have led to a paradigm shift in ANA testing for autoimmune diseases ( 63 ). Rapid throughput techniques have replaced traditional methods like IFA and ELISA in many clinical laboratories.…”

“…The test names such as “ANA Direct” and “ANA Screen” are confusing misnomers as these tests are not actually measuring the ANA itself. When unexpected results are reported (Case 3), there is uncertainty in interpreting the test report often precipitating referral for rheumatology consultation plus additional testing ( 63 ). ANA determination using a two-step sequential process would be recommended for patients undergoing evaluation for SLE (Case 2).…”