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Despite significant efforts and advances in the field of autoimmune diagnostics, the standardisation and proper use of antinuclear antibody (ANA) testing in clinical practice remains a challenge. Recently, important contributions attempting to clarify and add rigour to this area have been published.1 ,2 In particular, the recommendations published by Agmon-Levin et al1 address very important issues that confront contemporary laboratory medicine. Using a Delphi approach, the authors generated 25 recommendations for the detection of anticellular antibodies, previously referred to ANA, and anti-dsDNA antibodies. In a second important paper, Bossuyt and Fieuws reported added value of solid phase assays (SPA).2 Considering the high impact of published recommendations and associated editorials, careful verification, validation, clarification, education and, if necessary, adjustments are crucial. Some of the recent recommendations requiring further clarification are summarised and discussed in this article.
Terminology of diseases and autoantibodies
Agmon-Levin et al, make an exceedingly important point that the nomenclature of autoantibodies found in systemic autoimmune rheumatic disease (SARD) sera is inconsistent, misleading and/or not in keeping with contemporary cell and molecular biology terminology. The terms ‘antinuclear antibodies’ (ANA) and ‘extractable nuclear antigens’ (ENA) are no longer technically correct and do not cover the entire spectrum of relevant autoantibodies. ‘ANA’ using indirect immunofluorescence (IIF), as well as some other screening assays, detect antibodies directed against nuclear and non-nuclear elements (as in their recommendation 13), while ‘ENA’ may refer to some antigens that are neither extractable nor nuclear. Therefore, it is highly desirable to change these terms to more appropriate and informative ones, such as anticellular antibodies and specific antibodies, respectively. Such a change in nomenclature requires broad agreement and adoption within the broad stakeholder medical …