Is it useful to test for antibodies to extractable nuclear antigens in the presence of a negative antinuclear antibody on Hep-2 cells?

Antinuclear antibody (ANA) negative lupus has long been recognised as a distinct entity affecting a small number of patients with systemic lupus erythematosus (SLE).1 Initial estimates of the prevalence of this entity (5% of patients with lupus) were based upon studies using rodent tissues as substrate for antinuclear antibody testing. The increasing use of human epithelial cell lines (Hep-2 cells), which have greater sensitivity for extractable nuclear antibodies (ENA), has meant that new patients with true ANA negative lupus are now rarely encountered. Many immunology laboratories are faced with a substantial number of requests for antibodies to ENA and double stranded DNA, even in patients with negative ANA, on the grounds that patients with ANA negative lupus might go undetected. Using Hep-2 cells, we …