Frequency of Immunofluorescence Antinuclear Antibody Patterns: In A Local Population from North India

  • Rani Deepak Microbiology & Serology Section, City Xray & Scan Clinic Pvt. Ltd.,Tilak Nagar, New Delhi, India
  • Charu Agrawal Microbiology & Serology Section, City Xray & Scan Clinic Pvt. Ltd.,Tilak Nagar, New Delhi, India
  • Sunita Kapoor Microbiology & Serology Section, City Xray & Scan Clinic Pvt. Ltd.,Tilak Nagar, New Delhi, India
  • Ritesh Kanotra Department of Internal medicine, Banner Baywood Medical Center, Mesa, AZ, United States
Keywords: ANA, Autoimmune disorders, ANA patterns, IIF, ANA titer, ANA mixed patterns, Speckled, Homogenous


Background Autoimmune disorders in India have seen rise in recent times. The first-line test in diagnostic workup of autoimmune disorders is ANA indirect Immunofluorescence (IIF). A positive Antinuclear antibodies (ANA) result in conjunction with clinical findings aids in predicting the diagnosis. ANA test is not widely available in India, probably due to the cost and requirement of technical expertise. In view of rising incidence of autoimmune disorders in India and due to scarcity of data, this study aimed at determining prevalence of ANA positivity, study ANA patterns and their frequency and estimate disease burden in patients among local population of Northern India. Methods The study was performed on 2000 suspected autoimmune disorder patients during a period of 01 year (January 2023 till January 2024). Assessment of ANA patterns and titres were carried out by ANA-IIF technique. Result Of the 2000 participants, 30.8% were found to be ANA-positive. Nuclear speckled pattern was observed to be the most common, among others.  Among mixed ANA patterns, mix of speckled and homogenous patterns were common. Females showed predominance over males in all age groups in ratio of 3:1. Conclusion: The study is a preliminary, retrospective study providing overview of ANA positivity and autoimmunity status in Northern India, where despite the heavy disease burden, data is still scarce. Further studies in Indian population are essential to determine relationship of ANA with various etiologic and biochemical factors and association between ANA patterns and specific antibodies in serum for diagnosis of specific autoimmune diseases.


Gupta P, Agrawal P, Verma NR, et al. Antinuclear Antibody Profiling in Patients of a Tertiary Care Centre in Central India. Indian J Clin Biochem. 2021; 36(3):345-352.

Atassi MZ, Casali P. Molecular mechanisms of autoimmunity. Autoimmunity. 2008;41(2):123–132.

Peene I, Meheus L, Veys EM, De Keyser F. Detection and identification of antinuclear antibodies (ANA) in a large and consecutive cohort of serum samples referred for ANA testing. Ann Rheum Dis. 2001;60(12):1131–1136.

Smith DA, Germolec DR. Introduction to immunology and autoimmunity. Environ Health Perspect. 1999; 107(5):661-665.

Walravens M. Systemic diseases and the detection of nuclear and anticytoplasmic antibodies. A historical review. Clin Rheumatol. 1987; 6: 9-17.

Kumar Y, Bhatia A, Minz RW. Antinuclear antibodies and their detection methods in diagnosis of connective tissue diseases: a journey revisited. Diagn Pathol. 2009 Jan 2;4:1.

Choudhary V, Sharma A, Sharma VK, Sarswat P, Choudhary C. Determination and prevalence of antinuclear antibody (ANA) patterns in autoimmune disorders in a tertiary care hospital, Jaipur. Galore International Journal of Health Sciences and Research. 2022; 7(1): 26-32.

Arbuckle MR, McClain MT, Rubertone MV, et al. Development of autoantibodies before the clinical onset of systemic lupus erythematosus. N Eng J Med. 2003; 349: 1526.

Shiel WC Jr, Jason M. The diagnostic associations of patients with antinuclear antibodies referred to a community rheumatologist. J Rheumatol. 1989; 16: 782.

Folwaczny C, Noehl N, Endres SP, Heldwein W, Loeschke K, Fricke H. Antinuclear autoantibodies in patients with inflammatory bowel disease. High prevalence in first-degree relatives. Dig Dis Sci. 1997;42(8):1593-7.

Buchner C, Bryant C, Eslami A, Lakos G. Anti-nuclear antibody screening using HEp-2 cells. J Vis Exp. 2014 Jun 23;(88):e51211.

Brito Fde A, Santos SM, Ferreira GA, et al. Detection of anti-nuclear antibodies by indirect immunofluorescence on HEp-2 cells: setting the appropriate screening dilution for the diagnosis of autoimmune rheumatic diseases. Revista Brasileira de Reumatologia (English Edition), Volume 54, Issue 1, 2014, Pages 13-20, ISSN 2255-5021,

Agmon-Levin N, Damoiseaux J, Kallenberg C, et al.: International recommendations for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies. Ann Rheum Dis. 2014; 73(1):17-23.

Lightfoote MM, Chirmule N, Homburger HA, et al. Quality Assurance of Laboratory Tests for Autoantibodies to Nuclear Antigens: (1) Indirect Fluorescence Assay for Microscopy and (2) Microtiter Enzyme Immunoassay Methods; Approved Guideline-Second Edition. CLSI. 2006;26 [Internet]. ICAP International Consensus on ANA patterns; [cited 2015 May 19]. Available from:

Ghosh P, Dwivedi S, Naik S, et al. Antinuclear antibodies by indirect immunofluorescence: Optimum screening dilution for diagnosis of systemic lupus erythematosus. Indian J Med Res. 2007;126:34–38.

Kiuttu J, Hartikainen A, Makitalo R. Occurrence of antinuclear antibodies in an unselected pregnancy population. Gynecol Obstet Invest. 1994;37:160–163.

Sebastian W, Roy A, Kini U, Mullick S. Correlation of antinuclear antibody immunofluorescence patterns with immune profile using line immunoassay in the Indian scenario. Indian J PatholMicrobiol. 2010; 53:427-432.

Imran K, Loya A, Hameed M, Siddiqui IA, Sheikh UN. The Frequency of Immunofluorescence Antinuclear Antibody Patterns and Extractable Nuclear Antigen: Experience From a Large Laboratory in Pakistan. Cureus. 2023; 15(1): e33343.

Gupta P, Priya R, Nanda R, Patel S, Mohapatra E. A Hospital-Based Insight into the Antinuclear Antibody Patterns in Autoimmune Disorders. J Lab Physicians. 2020;12(2):115-120.

Minz R W, Kumar Y, Anand S, et al. Antinuclear antibody positive autoimmune disorders in North India: an appraisal. Rheumatol Int. 2012;32 (09): 2883–2888.

Krishna Sarkar, Nadeem Ahmad, Debamita Banik, N. P. Singh. Antinuclear Antibodies: A demographic profile from a Tertiary Healthcare Centre of Delhi. SVUInternational Journal of Medical Sciences. 2023; 6(2): 331-339.

Satoh M, Chan EK, Ho LA, et al. Prevalence and socio-demographic correlates of antinuclear antibodies in the United States. Arthritis Rheum 2012; 64(7): 2319.

Hayter SM, Cook MC. Autoimmunity reviews updated assess¬ment of the prevalence, spectrum and case definition of auto¬immune disease. Autoimmun Rev 2012;11(10):754–765

Ganguli P, Chakrabarty BK, Chopra M, Ray S. Antinuclear Antibodies status and Related Risk Factors in Non pregnant Adult Indian Women. Indian J Med Biochem, 2019; 23(2):250–3.

Akmatov M K, Röber N, Ahrens W et al. Anti-nuclear autoantibodies in the general German population: prevalence and lack of association with selected cardiovascular and metabolic disorders-findings of a multicenter population-based study. Arthritis Res Ther. 2017;19(01):127.

Ag S, Afsar I. Evaluation of antinuclear antibodies by indirect immunofluorescence and line immunoassay methods 0: four years 0 data from Turkey. APMIS. 2014;122(12):1167–1170.

Mengeloglu Z, Tas T, Kocoglu E, Aktas G, Karabörk S. Determination of anti-nuclear antibody pattern distribution and clinical relationship. Pak J Med Sci. 2014;30(02):380–383.

Feltkamp TE. Antinuclear antibody determination in a routine laboratory. Ann Rheum Dis. 1996;55:723–727.

Guo YP, Wang CG, Liu X, et al. The prevalence of antinuclear antibodies in the general population of china: a cross-sectional study. Curr Ther Res Clin Exp. 2014;76:116–119.

Original Article