Autoantibody Interpretation Guide

What each positive autoantibody and each combination means, with the published figures behind it · v1

  • Enter the ANA titre and pattern from the immunofluorescence report, if it was done.
  • Tick every antibody reported positive, under the panel it was tested on. "Find an antibody" narrows the list.
  • Answer the qualifiers that appear: the antiphospholipid level and whether it persisted, how a neuronal antibody was detected, and the GAD65 level.
  • You get the leading pattern, what each antibody and each combination means with the published figures behind it, and what else can produce these results.
  • Unticked means not entered, not negative. A rule that depends on a negative result says so in its title.

  • The clinical picture, classification criteria and the probability of disease. The Autoimmune Disease Workup Pathway takes those.
  • Cell-surface neuronal antibodies (NMDA receptor, LGI1, CASPR2, AQP4, MOG), and coeliac, thyroid, islet and other organ-specific antibodies not on this form.
  • Each laboratory's own units and cut-offs, beyond the ANA titre, the antiphospholipid level and the GAD65 level.
  • Children. Most figures come from adult cohorts, and juvenile disease was not reviewed.
  • A negative panel. The form records positives; an antibody left unticked is read as not entered.

1. ANA Screen (HEp-2 Immunofluorescence)

2. Antibodies Reported Positive

No antibody ticked yet.

ANA profile (line blot)

The 16 antigens most Indian laboratories report on the standard ANA line blot. Anti-dsDNA here also covers an ELISA, CLIA or CLIFT result.

Other lupus antibody
Extended myositis panel

Anti-Jo-1, PM-Scl and Ro52 are in the ANA profile above; tick them there.

Extended systemic sclerosis panel

Scl-70, centromere and PM-Scl are in the ANA profile above.

Rheumatoid arthritis serology
ANCA and anti-GBM

Immunofluorescence patterns first, then the antigen-specific immunoassays.

Antiphospholipid antibodies
Liver profile

AMA-M2 and Ro52 also appear on the ANA profile; tick each once.

Kidney

Anti-GBM is under ANCA above.

Blistering skin disease
Antibodies against gangliosides (IgM and IgG)
Antibodies against neuronal antigens (IgG)

The intracellular antigens on the neuronal line blot. Cell-surface antibodies such as NMDA receptor, LGI1, CASPR2, AQP4 and MOG are separate cell-based tests and are not interpreted here.

1. Reading an Antibody Result

Sensitivity says how often the disease carries the antibody; specificity says how often people without it do not. For an antibody that is found only in a minority of patients but rarely in anyone else, a positive result counts for more than a negative one.

TestSensitivitySpecificityWhat it means
ANA 1:80, for SLE97.8%74.7%Good for excluding SLE, weak for confirming it (Leuchten 2018)
Anti-dsDNA, for SLE52.4%94.2%Supports SLE; a negative does not exclude it (Bizzaro 2012)
RF, for RA69%85%Positive likelihood ratio about 4.9 (Braschi 2016)
Anti-CCP, for RA67%95%Positive likelihood ratio about 12.5 (Nishimura 2007)
PR3, for GPA74%About 97%Antigen-specific immunoassay is now the first test (Walker 2022)

The same result means more in a patient whose illness already looks like the disease. That is why this guide names a pattern and stops: weighing it against the clinical picture is the workup pathway's job.

2. The ANA in Healthy People

Across 15 international laboratories, healthy people were ANA-positive at every dilution, with no significant change between 20 and 60 years (Tan 1997).

TitreHealthy people positive
1:4031.7%
1:8013.3%
1:1605.0%
1:3203.3%
  • The pattern directs the next test, and a cytoplasmic pattern can hide behind a report of "ANA negative" (Damoiseaux 2019).
  • Dense fine speckled at high titre is the commonest pattern in healthy people; confirmed isolated anti-DFS70 is reassuring (Conrad 2017).
  • A negative ANA does not exclude anti-Ro60 or several myositis antibodies (Damoiseaux 2019).

3. Line Blots and Weak Bands

Most Indian laboratories report the ANA profile, the myositis and SSc panels, the liver profile and the neuronal panel as line blots. A weak band is where they go wrong.

  • Myositis antibodies are nearly always one per patient (0.2% had more than one) (Betteridge 2019). With higher local cut-offs, multiple positivity in controls fell from 7.2% to 1.1% (Wei 2025).
  • TIF1-gamma agrees poorly with immunoprecipitation (kappa 0.21) (Loganathan 2024).
  • Neuronal antigens: 48% of line-blot positives confirmed on tissue, and 8% of line-blot-only patients had a paraneoplastic syndrome (Ruiz-García 2020). Weak SOX1 bands confirmed in 23%, strong in 87% (Arnaldos-Pérez 2023).

4. Antibodies That Mean a Cancer Search

AntibodyCancerUsual tumour
TIF1-gamma (adult DM)41% pooled (Best 2019)Any; within three years of onset (IMACS 2023)
NXP2Incidence ratio 3.68 (Albayda 2017)Not specified
RNA polymerase III9.0% against 2.5% within two years of SSc onset (Lazzaroni 2017)Breast most often
Hu85% (Graus 2021)Small cell lung
YoMore than 90% (Graus 2021)Ovary, breast
Ma2More than 75% (Graus 2021)Testis in young men, lung in older patients
SOX1More than 90% (Graus 2021)Small cell lung
Tr (DNER)90% (Graus 2021)Hodgkin lymphoma
GAD65Fewer than 15% (Graus 2021)Small cell lung, neuroendocrine, thymoma

5. Infections That Produce Autoantibodies in India

Several antibodies on this form turn up in infections common here. Look for the infection before the autoimmune disease is named, and before immunosuppression.

  • Tuberculosis: anti-CCP in 39.6% of pulmonary TB in Prayagraj (Yadav 2020); ANCA in 44% of one series (Flores-Suárez 2003) and 10% of another (Teixeira 2005).
  • Leprosy: lupus anticoagulant in 68.6%, mostly IgM antiphospholipid antibodies, with no thrombosis (de Larrañaga 2000).
  • Hepatitis C: RF in 40 to 76% (Ingegnoli 2013); anti-LKM-1 in 5 to 10% (EASL 2015).
  • HIV: anticardiolipin in about half, rarely beta2GPI-dependent (Sène 2008).
  • Infective endocarditis: ANCA in 18%, PR3 or MPO in 8% (Mahr 2014).

6. What Indian Cohorts Show

  • SLE at diagnosis (2,503 patients, conference abstract): anti-dsDNA 70.2%, U1-RNP 52.0%, Ro60 42.1%, Sm 32.2%, La 12.3% (INSPIRE 2025).
  • Systemic sclerosis: anti-Scl-70 49.0% and anti-centromere 17.8% in the national registry, the reverse of many European cohorts (Philip 2024).
  • Anti-HMGCR myopathy in Indian series occurred without statin exposure (Khoo 2023).
  • Anti-PLA2R in 75% of primary membranous nephropathy in Chennai, none of secondary (Gopalakrishnan 2016).

7. What This Guide Does Not Do

  • It computes no probability and no criteria score. It names the leading pattern and prints the published figures, each with its source.
  • Absence is not negativity. A combination that depends on a negative test says so, because the form cannot tell untested from negative.
  • Where a figure could not be verified, none is printed, and the card says so: GD1b, GT1a and recoverin are the examples.
Abbreviations AASLD (American Association for the Study of Liver Diseases) · AC (Anti-Cell, the ICAP Pattern Code) · ACA (Anti-Centromere Antibody) · ACPA (Anti-Citrullinated Protein Antibody) · ACR (American College of Rheumatology) · AIH (Autoimmune Hepatitis) · AIIMS (All India Institute of Medical Sciences) · ALP (Alkaline Phosphatase) · ALT (Alanine Aminotransferase) · AMA (Anti-Mitochondrial Antibody) · ANA (Antinuclear Antibody) · ANCA (Antineutrophil Cytoplasmic Antibody) · ANNA (Anti-Neuronal Nuclear Antibody) · APASL (Asian Pacific Association for the Study of the Liver) · APS (Antiphospholipid Syndrome) · aPS (Anti-Phosphatidylserine) · aPTT (Activated Partial Thromboplastin Time) · AQP4 (Aquaporin-4) · ASMA (Anti-Smooth Muscle Antibody) · beta2GPI (Beta2-Glycoprotein I) · BP (Bullous Pemphigoid) · BP180 (Bullous Pemphigoid Antigen 180) · BP230 (Bullous Pemphigoid Antigen 230) · BTU (Bühlmann Titre Units) · CADM (Clinically Amyopathic Dermatomyositis) · CASPR2 (Contactin-Associated Protein-Like 2) · CCP (Cyclic Citrullinated Peptide) · CENP (Centromere Protein) · CK (Creatine Kinase) · CLIA (Chemiluminescence Immunoassay) · CLIFT (Crithidia Luciliae Immunofluorescence Test) · cN1A (Cytosolic 5'-Nucleotidase 1A) · CoA (Coenzyme A) · COVID (Coronavirus Disease) · CRMP5 (Collapsin Response-Mediator Protein 5) · CSF (Cerebrospinal Fluid) · CT (Computed Tomography) · CTD (Connective Tissue Disease) · DFS (Dense Fine Speckled) · DFS70 (Dense Fine Speckled 70 kDa Antigen) · DM (Dermatomyositis) · DNA (Deoxyribonucleic Acid) · DNER (Delta/Notch-Like EGF-Related Receptor) · DOAC (Direct Oral Anticoagulant) · DPP (Dipeptidyl Peptidase) · dRVVT (Dilute Russell Viper Venom Time) · dsDNA (Double-Stranded DNA) · EAN (European Academy of Neurology) · EASL (European Association for the Study of the Liver) · EGF (Epidermal Growth Factor) · eGFR (Estimated Glomerular Filtration Rate) · EGPA (Eosinophilic Granulomatosis with Polyangiitis) · ELISA (Enzyme-Linked Immunosorbent Assay) · EULAR (European Alliance of Associations for Rheumatology) · EUSTAR (EULAR Scleroderma Trials and Research Group) · GAD (Glutamic Acid Decarboxylase) · GBM (Glomerular Basement Membrane) · GBS (Guillain-Barré Syndrome) · GGT (Gamma-Glutamyl Transferase) · GPA (Granulomatosis with Polyangiitis) · HEp (Human Epithelial, as in the HEp-2 Cell Line) · HIV (Human Immunodeficiency Virus) · HMG (3-Hydroxy-3-Methylglutaryl) · HMGCR (3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase) · IBM (Inclusion Body Myositis) · ICAP (International Consensus on Antinuclear Antibody Patterns) · IgA (Immunoglobulin A) · IgG (Immunoglobulin G) · IgM (Immunoglobulin M) · IGOS (International Guillain-Barré Syndrome Outcome Study) · ILD (Interstitial Lung Disease) · IMACS (International Myositis Assessment and Clinical Studies Group) · INSPIRE (Indian SLE Inception Cohort for Research) · IPSSR (Indian Progressive Systemic Sclerosis Registry) · ISTH (International Society on Thrombosis and Haemostasis) · IU (International Units) · KDIGO (Kidney Disease: Improving Global Outcomes) · LA (Lupus Anticoagulant) · LC (Liver Cytosol) · LEDGF (Lens Epithelium-Derived Growth Factor) · LGI1 (Leucine-Rich Glioma-Inactivated 1) · LKM (Liver Kidney Microsomal) · LP (Liver Pancreas) · MAG (Myelin-Associated Glycoprotein) · MCTD (Mixed Connective Tissue Disease) · MDA5 (Melanoma Differentiation-Associated Gene 5) · MMN (Multifocal Motor Neuropathy) · MN (Membranous Nephropathy) · MOG (Myelin Oligodendrocyte Glycoprotein) · MPA (Microscopic Polyangiitis) · MPO (Myeloperoxidase) · MRP (Mitochondrial RNA Processing) · NMDA (N-Methyl-D-Aspartate) · NOR90 (Nucleolar Organiser Region 90) · NOVA (Neuro-Oncological Ventral Antigen) · nRNP (Nuclear Ribonucleoprotein) · NXP2 (Nuclear Matrix Protein 2) · PBC (Primary Biliary Cholangitis) · PCA (Purkinje Cell Antibody) · PCNA (Proliferating Cell Nuclear Antigen) · PDC (Pyruvate Dehydrogenase Complex) · PET (Positron Emission Tomography) · PF (Pemphigus Foliaceus) · PLA2R (Phospholipase A2 Receptor) · PM (Polymyositis) · PML (Promyelocytic Leukaemia Protein) · PNS (Paraneoplastic Neurological Syndrome) · PR3 (Proteinase 3) · PT (Prothrombin) · PV (Pemphigus Vulgaris) · RA (Rheumatoid Arthritis) · RF (Rheumatoid Factor) · RNA (Ribonucleic Acid) · RNase (Ribonuclease) · RNP (Ribonucleoprotein) · SAE (SUMO-Activating Enzyme) · SLA (Soluble Liver Antigen) · SLE (Systemic Lupus Erythematosus) · SMA (Smooth Muscle Antibody) · SOX1 (SRY-Box Transcription Factor 1) · SRP (Signal Recognition Particle) · SS (Sjögren Syndrome) · SSA (Sjögren Syndrome Antigen A) · SSc (Systemic Sclerosis) · SUMO (Small Ubiquitin-Like Modifier) · TB (Tuberculosis) · THSD7A (Thrombospondin Type-1 Domain-Containing 7A) · TIF1 (Transcriptional Intermediary Factor 1) · TNF (Tumour Necrosis Factor) · tRNA (Transfer RNA) · US (United States) · ZIC (Zinc Finger of the Cerebellum)
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How to Cite This Tool

AMA Style:Umakanth S. Autoantibody Interpretation Guide. Version 1. MEDiscuss Clinical Decision Support System. Published 2026. Accessed . https://mediscuss.org/cdss/autoantibody-interpretation

Vancouver Style:Umakanth S. Autoantibody Interpretation Guide [Internet]. Version 1. MEDiscuss.org; 2026 [cited ]. Available from: https://mediscuss.org/cdss/autoantibody-interpretation

Disclaimer and scope
Disclaimer: This decision-support system is written for healthcare professionals. It does not substitute clinical judgment, and the treating physician retains absolute responsibility for every diagnostic, dosing and therapeutic decision. The algorithms are built on the evidence as it stands, and the evidence moves. Verify the output against your current institutional protocol, and against the patient in front of you.
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Category Advanced DiagnosticsGuide
Specialties Immunology, Internal Medicine, Rheumatology, Nephrology, Neurology, Dermatology, Hepatology

Written and maintained by

Dr Shashikiran Umakanth

Last revised 28 September 2026

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