Appropriateness in anti-nuclear antibody testing: from clinical request to strategic laboratory practice

As a result of rapid changes in laboratory technology, clinical behaviour and patients' expectations, along with limited economic resources, there is a greater requirement for an appropriate use of autoantibody testing. We examine the various aspects and the most controversial points of the diagnostic procedure in systemic autoimmune rheumatic diseases, and make recommendations for the most efficient approach to autoantibody testing, based on selected publications and the relevant literature. Appropriateness is a complex task that can be achieved only by combining the efforts from the laboratory and the clinic, thereby using scientific knowledge, inter-disciplinary consultation and expert clinical investigation.