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Unending story of the indirect immunofluorescence assay on HEp-2 cells: old problems and new solutions?
  1. Pier Luigi Meroni1,
  2. Edward K Chan2,
  3. Jan Damoiseaux3,
  4. Luís Eduardo Coelho Andrade4,
  5. Xavier Bossuyt5,
  6. Karsten Conrad6,
  7. Xavier Mariette7,
  8. Joanna Sheldon8,
  9. Johan Rönnelid9,
  10. Marvin J Fritzler10
  11. On behalf of the members of the committees
  1. 1Immunorheumatology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
  2. 2Department of Oral Biology, University of Florida, Gainesville, Florida, USA
  3. 3Laboratory Specialist Medical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
  4. 4Departamento de Reumatologia, Fleury Laboratory, Immunology, Universidade Federal de São Paulo, Sao Paulo, Brazil
  5. 5Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
  6. 6Institut für Immunologie Medizinische, Carl Gustav Carus" der Technischen Universität Dresden, Dresden, Germany
  7. 7Department of Rheumatology, Université Paris-Sud, Paris, France
  8. 8Center for Infection and Immunity Research, St George’s, University of London, London, UK
  9. 9Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
  10. 10Department of Medicine and Biochemistry and Molecular Biology, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Professor Pier Luigi Meroni, IRCCS Istituto Auxologico Italiano; pierluigi.meroni{at}

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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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