Antinuclear Antibodies (ANA) Save

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 required for SLE, but the criteria are clear that positivity can occur once EVER, with a titer equal to or greater than 1:80. By perpetuating the misconception that ANAs of 1:80 or 1:160 are meaningless, the under-diagnosis of indolent, atypical 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 thinking. Late-onset SLE is recognized to have a more subtle presentation, with less impressive antibody profiles, and diagnosis is often delayed or missed entirely because of outdated ideology and practices. Despite generally lower disease activity levels, late-onset SLE patients have higher accrued organ damage and mortality rates 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!