ArticleCureus2025
Diagnostic Utility of Antibodies to Extractable Nuclear Antigens in the Absence of Positive Antinuclear Antibodies.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Real-World Evaluation of ANA Testing Pathways: Serological Incompleteness and Comparison of Stepwise Versus Upfront Parallel Reflex Strategies.Biomedicines · 2026Article
- Autoantibody Ordering Patterns Across a Tertiary Hospital: A Retrospective Audit.Open access rheumatology : research and reviews · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe antinuclear antibody (ANA) test by indirect immunofluorescence (IFA) is highly sensitive for systemic autoimmune rheumatic diseases (SARD), however, its specificity is low, necessitating additional testing for antibodies to extractable nuclear antigens (ENA). The American College of Rheumatology recommends screening with the ANA by IFA but advises against testing further if the ANA is negative. This is based primarily upon consensus opinion and a limited number of studies. This study further investigates the utility of an isolated positive ENA in patients with negative ANA followed over time and evaluated by a rheumatologist, the first such study to do so.
methodsAll patients aged ≥18 years seen at the University of Cincinnati Medical Center who tested negative for ANA and positive for ENA within a 30-day window between April 2015 and April 2024 and were evaluated by a rheumatologist on at least one occasion constituted the study population. Clinical diagnoses were established by board-certified rheumatologists and independently verified through electronic medical record review by a second rheumatologist.
resultsAmong 4,462 patients undergoing ANA testing with subsequent rheumatology evaluation, 1,594 had concurrent ENA testing. Of these, 72 patients (4.5%) exhibited ENA positivity despite negative ANA results. Only four of the 72 ANA-negative, ENA-positive patients (5.6%) received a new diagnosis of a SARD.
conclusionsThe utility of testing for ENA when the ANA by IFA is negative is low. The vast majority of positive tests are false positives that lead to additional testing at additional costs.
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Registered trials
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