I don’t agree with any of the rules. 1) doorder ana if no clinical lupus.ANA may be helpful for RA, sjogrrns, scleroderma, myositis 2)repeat ANA. It comes and goes 3)order subserologies. ENA, SSA,SSB. Very helpful may show lupus. 4) absolutely not. Look at new studies showing up to 24% Ana negativity in established lupus. 5) Ana neg RA, other ctd, even sle is seen. 6) do refer low pos Ana if PAIN is present. It is very helpful in outcome, response to dmard. Thank you.