title: Cost-effective detection of non-antidouble-stranded DNA antinuclear antibody specificities in daily clinical practice.
abstract: OBJECTIVE
  To compare the utility of indirect immunofluorescence for the detection of antinuclear antibodies (ANA-IIF) and a fully automated test (ELiA Symphony) that detects antibodies against a mixture of nuclear and cytoplasmic antigens (ENA), to select sera that should be tested for non-antidouble-stranded DNA (dsDNA) antinuclear antibodies in a relatively expensive automated line immunoassay (INNO-LIA ANA update, Lineblot).
  
  
  METHODS
  All 328 sera sent to the laboratory for ANA or anti-ENA tests, over a 4 month period were evaluated in all three assays. Results were related to signs and symptoms of systemic autoimmune disease (AID) that patients had before or at the time of blood sampling.
  
  
  RESULTS
  Overall, 72 (22%) sera were Lineblot positive. Of 198 patients without clinical manifestations of AID, 7% were Lineblot positive. Limiting Lineblot to sera positive in either ANA-IIF or Symphony tests failed to detect 26 (ANA-IIF) and 22 (Symphony) Lineblot-reactive sera, with 15 sera being negative in both assays. From a clinical point of view, failure to detect these reactivities was not important in most cases.
  
  
  CONCLUSIONS
  Restriction of performance of Lineblot to patients with at least one criterion for AID is an ideal and cost-effective strategy. In ignorance of clinical signs and symptoms, screening of sera by ANA-IIF or Symphony strongly reduces the costs of anti-ENA detection, with minimal loss in diagnostic capacity. Based on small differences, including the fact that anti-dsDNA antibodies give a positive ANA-IIF, we prefer screening with ANA-IIF over Symphony.
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Centre, PO Box 85500, 3508 GA Utrecht, The Netherlands. p.a.j.m.vos@azu.nl
authors.forename: P A J M
authors.initials: PA
authors.lastname: Vos
authors.forename: E J E G
authors.initials: EJ
authors.lastname: Bast
authors.forename: R H W M
authors.initials: RH
authors.lastname: Derksen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000974:Antibodies, Antinuclear / Q000097:blood*; D001327:Autoimmune Diseases / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004247:DNA / Q000276:immunology; D019084:Fluorescent Antibody Technique, Indirect / Q000191:economics / Q000379:methods; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007118:Immunoassay / Q000191:economics / Q000379:methods; D007223:Infant; D008875:Middle Aged; D009426:Netherlands; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D000974:Antibodies, Antinuclear; D015415:Biomarkers; D004247:DNA