{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:02:46Z","timestamp":1780470166526,"version":"3.54.1"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The anti-rods and rings (anti-RR) pattern (AC-23) is traditionally associated with Hepatitis C Virus (HCV) infection and interferon therapy. However, emerging evidence suggests a broader clinical spectrum. This study aims to characterize the clinical associations, demographic shifts, and pattern complexity of anti-RR antibodies in a single-center retrospective study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted on anti-RR-positive individuals identified from both the clinical cohort and the routine health checkup cohort. Clinical data, including disease categories, age, gender, concurrent ANA patterns, and antibody titers, were systematically evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our findings demonstrate a heterogeneous clinical distribution of the anti-RR (AC-23) pattern across disease categories. Within the infectious disease group, hepatitis B virus (HBV) accounted for the largest proportion (36.59%), followed by hepatitis C virus (HCV) (24.39%), with a male predominance (M:F = 2.4:1, p&amp;lt;0.05). Among systemic autoimmune diseases, rheumatoid arthritis (RA) was the most frequently observed condition (25.64%), followed by connective tissue diseases (CTD) and autoimmune liver diseases (AIH\/PBC). A distinct age- and sex-related distribution was observed, with higher frequencies in females aged 19\u201345 years, whereas a higher frequency was observed in males aged &amp;gt;65 years within the clinical cohort (p=0.045). Overall, anti-RR antibodies were predominantly detected at low titers (1:100\u20131:320). In addition, multiple immunofluorescence patterns, particularly speckled patterns, were more frequently observed in patients with autoimmune diseases, whereas isolated anti-RR patterns were more commonly identified in the routine health checkup cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Anti-RR represents a distinct ANA pattern associated with a broad clinical spectrum in the Chinese population, extending significantly beyond HCV to include HBV infection and various non-infectious conditions. The diverse clinical associations and the predominance of low-to-moderate titers suggest that anti-RR should be interpreted as a general indicator of systemic immune involvement rather than a specific disease marker. Clinical management should prioritize comprehensive evaluation based on the individual\u2019s context rather than relying on anti-RR for specific disease screening.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1831506","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:05:53Z","timestamp":1780466753000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond hepatitis C: clinical spectrum and demographic characteristics of anti-rods and rings antibodies in a large ANA-positive cohort"],"prefix":"10.3389","volume":"17","author":[{"given":"Pingping","family":"Wang","sequence":"first","affiliation":[{"name":"Clinical Laboratory Center, Gansu Provincial Maternity and Child-Care Hospital","place":["Lanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiji","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingting","family":"Liu","sequence":"additional","affiliation":[{"name":"Clinical Laboratory Center, Gansu Provincial Maternity and Child-Care Hospital","place":["Lanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianying","family":"Pei","sequence":"additional","affiliation":[{"name":"Clinical Laboratory Center, Gansu Provincial Maternity and Child-Care Hospital","place":["Lanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Clinical Laboratory Center, Gansu Provincial Maternity and Child-Care Hospital","place":["Lanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, 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