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The paper by Pisetsky et al raised some critical points on the indirect immunofluorescence assay (IFA) on HEp-2 cells (HEp-2 IFA): (1) the low antinuclear antibodies (ANA) pretest and post-test probability, and (2) the variability of the IFA ANA result depending on the method type and reagent source.1 One consequence of these points is the heterogeneity in the classification criteria for systemic lupus erythematosus and/or the inclusion criteria in clinical trials or in specific treatment protocols.
Unfortunately, the paper by Pisetsky et al conveys no practical suggestions on how to minimise these issues, and the impact on the readers could be one of confusion rather than resolution.
Several international committees are joining their efforts in order to avoid misdiagnosis and …
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