One individual with undifferentiated connective tissue disease did not match AARD or non-AARD and was classified as unresolved. to obtain demographic and clinical information and a serological database was used to retrieve specific ANA and/or (Rac)-BAY1238097 extractable nuclear antigen (ENA) test results. Clinical information was extracted from your consulting rheumatologist’s statement. == Results == 15,357 patients were referred through the CT system; 643 (4.1%) of these because of a positive ANA and of these 263 (40.9%) were evaluated by a qualified rheumatologist. In 63/263 (24%) of ANA positive patients, the specialist provided a diagnosis of an ANA associated rheumatic disease (Rac)-BAY1238097 (AARD) while 69 (26.2%) had no evidence of any disease; 102 (38.8%) had other rheumatologic diagnoses and 29 (11%) had conditions that did not meet AARD classification criteria. Of ANA positive archived sera, 15.1% were anti-DFS70 positive and 91.2% of these did not have an AARD. == Conclusions == This is the first Mouse monoclonal to CD247 study to evaluate the serological and clinical features of patients referred through a CT system because of a positive ANA. The spectrum of autoantibody specificities was wide with anti-Ro52/TRIM21 being the most common autoantibody detected. Approximately 15% of referrals (Rac)-BAY1238097 had only antibodies to DFS70, the vast majority of which did not have clinical evidence for an AARD. These findings provide insight into the power of autoantibody screening in a CT system. == Introduction == The detection of anti-nuclear antibodies (ANA) has been established as an important adjunct to the diagnosis and classification of ANA-associated rheumatic diseases (AARD) such as systemic lupus erythematosus (SLE), systemic sclerosis (SSc), mixed connective tissue disease (MCTD), idiopathic inflammatory myopathies (IIM) and Sjgren’s syndrome (SjS)[1]. Nevertheless, issues have been raised concerning the ANA test as a screen for AARD[2],[3]and that positive assessments inappropriately prompt unwarranted referrals from main and secondary care physicians to tertiary care specialists[4][6]. Some issues about ANA assessments as an approach to screening for AARD are based on studies of the frequency of ANA in the healthy individuals[7]and calculations of pre-test probabilities and the clinical challenge of interpreting a positive test when the patient has no apparent evidence for any definitive diagnosis of, nor meets the classification criteria for, an AARD[3][5],[8]. The limitations of ANA and the related ENA assessments have been offset by at least three key findings. First, for several decades it has been appreciated that some autoantibodies are highly specific for certain AARD[9],[10]. Hence, when disease specific autoantibodies, such as anti-dsDNA antibodies in SLE, anti-centromere antibodies in SSc and anti-Jo-1 antibodies in IIM are detected in the absence of diagnostic or classification criteria for these conditions the clinician is often uncertain concerning the advice to give to the referring physician or the patient. This issue is usually linked to a second key obtaining wherein it now well established that ANA and disease-specific autoantibodies can pre-date the clinical diagnosis of AARD by as many as two decades[11][13]. Thus, in the context of a person with a positive ANA where the specific autoantibody is known, the physician should take care before advising the patient that they do not have an AARD. Third, there is growing evidence that autoantibodies directed against the dense fine speckled 70 (DFS70) antigen without accompanying disease specific antibodies are rare in AARD and may be useful biomarker to rule out these conditions[14][17]. All three of these issues are of particular importance when patients are referred to a rheumatology central triage system because of a positive ANA test. Key questions are: 1) are such referrals inappropriate and a waste of health care resources, and 2) can the specificities of ANA and related autoantibodies inform the triage process to (Rac)-BAY1238097 define the urgency of a specific referral to a specialist? Accordingly, the goals of this study were firstly to examine the ANA/ENA profiles of patients referred through a rheumatology central triage system; secondly, to determine if ANA/ENA of a given specificity were attended by a specific diagnosis and, thirdly, to determine the frequency of autoantibodies directed to DFS70 in a ANA referral cohort and elucidate the possible association of these antibodies to a specific diagnosis. (Rac)-BAY1238097 == Materials and Methods == == Ethics Statement == This study was approved by the University or college of Calgary Conjoint Health Research Ethics Table (Ethics ID#: E-24353). Under the terms of this approval, all patient records and information was anonymized and de-identified prior to analysis, precluding the requirement of written informed consent. All clinical investigation was conducted according to the principles expressed.