Does the ANA or anti-cytoplasmic antibody pattern have any diagnostic value?

There is often a correlation between the ANA pattern and the presence of anti-DNA and autoantibodies to other intracellular autoantigens. Identification of the staining pattern is useful for the laboratory because it may influence the search for the most appropriate autoantibodies by disease specific autoantibody profiles or other more specific tests. For example, in the presence of a cytoplasmic or nuclear dot type of fluorescence, an immunoassay that includes the cytoplasmic antigens Jo-1, M2/PDC (mitochondria), ribosomal P, EEA1, GW Bodies or the Sp-100 autoantigens, may be indicated (3). In the presence of a homogenous pattern, a search for dsDNA, histone or chromatin antibodies may be indicated. Anti-nucleolar patterns remain one of the main challenges for the clinical laboratory because it is difficult using current technologies to identify the target antigens (fibrillarin, B23, PM/Scl, Pol I/III, Th/To and others) (4). However, when an anti-centromere pattern is present, confirmation is usually not necessary. More recently, there has been attention to the dense fine speckled (DFS) pattern and evidence indicating that patients with ‘monospecific’ anti-DFS antibodies DO NOT have an autoantibody associated rheumatic disease (5).