Vol.:(0123456789) 1 3 Immunologic Research https://doi.org/10.1007/s12026-022-09347-z ORIGINAL ARTICLE ANA‑specifc antibodies, ANA patterns, anti‑ds‑DNA results, and clinical diagnosis: a laboratory and clinical audit Sabiha Anis 1  · Areej Fatima 2  · Sidra Abdul Jabbar 2  · Tayyab Arain 2 Received: 25 July 2022 / Accepted: 23 November 2022 © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022 Abstract The diagnosis of systemic autoimmune diseases (SAID) is challenging, due to overlapping features with other non-immune disorders. Anti-nuclear antibodies (ANA)/anti-cellular antibodies are the sensitive screening tests but anti-double-stranded- deoxyribonucleic acid-antibody (anti-ds-DNA) and ANA-specifc antibodies are specifc for SAID. We aimed to look at ANA-specifc antibodies in our patients and correlated them with ANA patterns, anti-ds-DNA, and clinical diagnosis for proper interpretation and better patient management cost-efectively. A retrospective data analysis of 641 patients was done (1st of February 2019 to 31st of July 2021) who were tested for ANA-specifc antibodies at the Immunology Department of Indus Hospital and Health Network. ANA and anti-ds-DNA results and clinical diagnosis were also analyzed for ANA- specifc antibody-positive patients. Descriptive data were presented in mean ± standard deviation and frequency percent- ages whereas inferential data were analyzed with a chi-square test for association between ANA-specifc antibodies status, ANA, anti-ds-DNA, and clinical features. ANA-specifc antibodies test revealed positivity for at least one autoantibody in 245 (38.2%) patients. Of these, ANA was tested in 206 patients reactive for ANA-specifc antibodies and found positive in 195 (95%) as compared to negative (< 0.001). Speckled and homogenous were predominant ANA patterns in ANA-specifc antibody-positives (56% and 42% respectively). Multiple ANA patterns were found in 18 patients most commonly with systemic lupus erythematosus (SLE) and mixed connective tissue disorder (MCTD). Anti-SSA were the most common ANA-specifc antibodies (50%) and were mostly found in sera with speckled (61/97) and homogenous (38/97) patterns and associated mostly with SLE (48%) and Sjogren’s syndrome (86%). Among ANA-negative patients, anti-SSA were the most common antibodies (n = 5). Anti-ds-DNA was found in 66% of SLE patients along with another ANA-specifc antibody. This study showed that testing for ANA-specifc antibodies cannot be gated on ANA patterns. Also, there is a redundancy of these antibodies with various clinical diagnoses. Moreover, they are useful in making a diagnosis in ANA-negative patients as well with clinical suspicion. Keywords Systemic autoimmune diseases · Antigen-specifc anti-nuclear antibodies · Anti-nuclear antibodies · ANA patterns · Anti-ds-DNA · Anti-cellular antibodies Introduction Systemic autoimmune diseases (SAID) or connective tissue disorders (CTD) comprise 5–10% of the burden of chronic debilitating diseases causing morbidity and mortality. Over a hundred SAID are already known. The clinical features of SAID overlap with infectious diseases or other non-immune- mediated disorders. This makes the diagnosis of these dis- orders challenging. Furthermore, these various SAID often coexist, imposing more challenges to diagnosing and man- aging these disorders. A battery of immunological and non- immunological tests is required for a conclusive diagnosis of SAID [1–3]. * Sabiha Anis Sabiha.anis@tih.org.pk; Sabiha_anis@hotmail.com Areej Fatima areej.fatima@tih.org.pk Sidra Abdul Jabbar sidra.jabbar@tih.org.pk Tayyab Arain tayyab.arain@tih.org.pk 1 Department of Pathology and Department of Medicine and Allied, The Indus Hospital and Health Network (IHHN), Karachi, Pakistan 2 Department of Pathology, The Indus Hospital and Health Network (IHHN), Karachi, Pakistan