NZ - I respectfully disagree. All guidelines say that ordering further serologies with a negative ANA is wrong, costly and more likely to be misleading thant accurate. These ELISA assays are TOOO TOOO sensitive - therein lies their major fault. You cannot claim that as a reason or justifcation. ENA are only useful with ANA+ and only to identify SSA or Sm Abs. All other information is nice but in reality doesnt change dx, treatment or prognosis. If you dont believe me, ask a serology and autoimmune expert that doesnt own a serology laboratory. Best wishes, JC