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Rare ANA patterns and their clinical correlates: a retrospective large-cohort study
Renren Ouyang1, Xuebing Zhang1, Lian Wang1
1Department of Laboratory Medicine, 66375 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei Province, China.
Clinical Chemistry and Laboratory Medicine
|March 5, 2026
Summary
Rare antinuclear antibody (ANA) patterns have unique associations with specific diseases and antibody titers. Identifying these rare ANA patterns can improve diagnostic accuracy when combined with clinical information.
Area of Science:
- Immunology
- Clinical Diagnostics
- Serology
Background:
- Antinuclear antibody (ANA) testing is crucial for diagnosing autoimmune diseases.
- Rare HEp-2 indirect immunofluorescence ANA patterns require further investigation for their clinical significance.
Purpose of the Study:
- To determine the prevalence and clinical associations of rare HEp-2 indirect immunofluorescence ANA patterns.
- To evaluate the relationship between rare ANA patterns, disease categories, ANA titers, and expression forms.
Main Methods:
- Retrospective analysis of 366,524 ANA tests (2018-2024) using 2018 ICAP update pattern definitions.
- Rare patterns defined as <1% of ANA-positive cases with >30 samples.
- Clinical diagnoses categorized into autoimmune, metabolic, infectious, neoplastic, or unclassified.
Main Results:
- 2.2% of ANA-positive cases exhibited rare patterns, with AC-22, AC-23, AC-25, AC-26, and AC-29 being most frequent.
- AC-29 was linked to autoimmune diseases like systemic sclerosis (96.2% anti-Scl-70 positive).
- AC-22 and AC-23 were associated with metabolic/infectious diseases at low titers, while AC-26 showed titer-dependent enrichment in autoimmune cases.
Conclusions:
- Rare ANA patterns demonstrate distinct profiles related to specific diseases and titers.
- Recognizing these rare patterns aids in enhancing diagnostic accuracy when integrated with clinical and serological data.
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