Antinuclear Antibody Testing: Gold Standard Revisited

Abstract

Antinuclear antibody (ANA) testing dates back over 70 years (1) and is one of the few surviving immunoassays from the 1960s and 1970 era. Although the conceptual use of indirect immunofluorescence assays (IFA) at the core of ANA testing has remained relatively unchanged, the technical aspects and microscopy components (i.e., optics, light sources, robotics, “intelligent” pattern reading) and cost-effectiveness have remarkably changed [reviewed in (2, 3)]. In parallel with the evolution of ANA testing, there has been a continuous increase in the individual autoantibodies and related ANA IFA staining patterns described in an ever-increasing spectrum of autoimmune diseases investigated by a wide diversity of clinical specialists and subspecialists (4). This has meant that in a current clinical setting, the pretest probability of ANA testing, initially used as an approach to the diagnosis of systemic lupus erythematosus (SLE), has markedly decreased...