With respect, Dr. Cush, your comments regarding ANA positivity and titer levels are not consistent with the 2019 EULAR/ACR clinical criteria for SLE. As you know, ANA positivity is the entry criterion for SLE. The criteria clearly state that once EVER positivity at a titer equal to or greater than 1:80 meets this requirement. By perpetuating the misconception that ANAs of 1:80 or 1:160 are meaningless, the under-diagnosis of less common phenotypes (e.g. late-onset SLE) will continue. Late-onset SLE patients are being missed because the rheumatological community has failed to embrace the current criteria. This phenotype is recognized to have a more subtle presentation with less impressive antibody profiles, and diagnosis is often delayed or missed because of outdated ideology and practices. Despite generally lower disease activity levels, late-on SLE patients have higher mortality rates and accrued organ damage because of these delays. The EULAR/ACR clinical criteria have been rigorously formulated and validated; why, then, does it take so long for them to be utilized? Please reference the current EULAR/ACR criteria in your podcasts. Thank-you for the excellent work you do!