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Antinuclear Antibody, Rheumatoid Factor, and Cyclic-Citrullinated Peptide Testing for the Evaluation of Musculoskeletal Complaints in Pediatric Populations

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Background: Antinuclear Antibody Test

An antinuclear antibody (ANA) test can be used to screen for specific autoimmune conditions such as systemic lupus erythematosus, Sjögrens syndrome, and systemic sclerosis. The gold standard for ANA testing is the indirect immunofluorescence (IIF) ANA test, which involves incubation of serial dilutions of the patient’s sera with substrate cells, usually a human epithelial tumor cell line (HEp-2). The interpretation of test results may be somewhat subjective and vary from one laboratory to another; titers from one laboratory cannot be compared with those from another. Detection of antibodies may also be assessed with an enzyme immunoassay (EIA). EIA methods and expected results vary among manufacturers because there is no agreed upon standard for the antigen preparations that should be included or for the concentration(s) of the relevant antigen preparations. Results of studies that compare the use of IIF and EIA for ANA testing have been inconsistent, with some showing poor correlation and others demonstrating consistency.