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Response to ‘Decision making value of nuclear dense fine speckled pattern in systemic autoimmune rheumatic disease: trick or treat?’ by Deng et al
  1. Luis Eduardo Coelho Andrade1,
  2. Jan Damoiseaux2,
  3. Edward K Chan3
  1. 1 Rheumatology Division, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
  2. 2 Maastricht University Medical Centre, Maastricht, The Netherlands
  3. 3 Department of Oral Biology, University of Florida, Gainesville, Florida, USA
  1. Correspondence to Dr Jan Damoiseaux, Maastricht University Medical Center, Maastricht 6229 HX, Netherlands; jan.damoiseaux{at}

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The correspondence of Deng et al 1 raises practical issues regarding the recognition and clinical interpretation of the nuclear dense fine speckled (DFS, AC-2) pattern in a typical clinical immunology laboratory during antinuclear antibody (ANA) screening using indirect immunofluorescence assay on HEp-2 cells (HEp-2 IIFA). Based on the recommendation of the International Consensus on ANA Patterns (ICAP),2 the recognition of a nuclear DFS pattern is not to be taken as the same as the determination of an anti-DFS70 antibody using a follow-up specific immunoassay. In fact, HEp-2 IIFA is a screening test for a vast array of autoantibodies and is not intended for the final determination of autoantibody specificity. Accordingly, the ICAP recommendation is clear that all HEp-2 IIFA patterns as defined by ICAP, with the sole exception of anti-centromere (AC-3), must be followed-up with specific immunoassays.2 With specific …

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