Current Concepts and Future Directions for the Assessment of Autoantibodies to Cellular Antigens Referred to as Anti-Nuclear Antibodies

Figure 2

Change in referral patterns. Historically, when the ANA HEp-2 test became available in around 1960 exclusively rheumatologist and clinical immunologists ordered the ANA test. With the emerging recognition that many other diseases are associated with ANAs, a broad range of clinical disciplines order the ANA test. With changes in the ANA referral pattern and the associated decrease in the pretest probability, the posttest probability significantly decreases (indicated by the triangle).