{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T21:04:48Z","timestamp":1791493488277,"version":"4.3.4"},"reference-count":35,"publisher":"Walter de Gruyter GmbH","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_cclm-2025-1493_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine the prevalence and clinical associations of rare HEp 2 indirect immunofluorescence ANA patterns and to evaluate their relationships with disease categories, ANA titers, and expression\u00a0form.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-1493_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 366,524 ANA tests performed between 2018 and 2024 using pattern definitions based on the 2018 ICAP update. Rare patterns were defined as those occurring in less than 1\u202f% of ANA positive cases and represented by more than 30 samples. Clinical diagnoses were categorized as autoimmune, metabolic, infectious, neoplastic, or unclassified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-1493_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 81,860 ANA positive cases (22.3\u202f%), 1,769 (2.2\u202f%) showed rare patterns. The most frequent rare patterns were AC-22 (0.7\u202f%), AC-23 (0.41\u202f%), AC-25 (0.25\u202f%), AC-26 (0.23\u202f%) and AC-29 (0.16\u202f%). AC-29 was largely confined to autoimmune diseases, particularly systemic sclerosis, and was often observed at high titers. For AC-26, higher titers were more frequently observed among autoimmune disease cases, suggesting titer dependent enrichment. By contrast, AC-22 and AC-23 were more frequently observed in metabolic or infectious diseases and were mainly characterized by low titers (\u22641:320). Cytoplasmic and mitotic patterns more commonly appeared as mixed patterns and showed broader distributions across disease categories. Among patients with systemic sclerosis exhibiting the AC-29 pattern, 96.2\u202f% were positive for anti-Scl-70 antibodies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-1493_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rare ANA patterns show distinct disease and titer profiles. Recognition of these patterns may enhance diagnostic accuracy when interpreted in conjunction with clinical and serological findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/cclm-2025-1493","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T10:05:21Z","timestamp":1772705121000},"page":"1636-1646","source":"Crossref","is-referenced-by-count":1,"title":["Rare ANA patterns and their clinical correlates: a retrospective large-cohort study"],"prefix":"10.1515","volume":"64","author":[{"given":"Renren","family":"Ouyang","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine , 66375 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei Province , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuebing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , 66375 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei Province , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lian","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , 66375 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei Province , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , 66375 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei Province , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rujia","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , 66375 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei Province , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , 66375 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei Province , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2337-0509","authenticated-orcid":false,"given":"Hongyan","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , 66375 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei Province , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0238-6926","authenticated-orcid":false,"given":"Shiji","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , 66375 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei Province , China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"2026060518413030193_j_cclm-2025-1493_ref_001","doi-asserted-by":"crossref","unstructured":"Tan, EM, Feltkamp, TE, Smolen, JS, Butcher, B, Dawkins, R, Fritzler, MJ, et al.. 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