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HelpTest Code CTDC Connective Tissue Diseases Cascade, Serum
Reporting Name
Connective Tissue Disease Cascade,SUseful For
Evaluation of patients with signs and symptoms compatible with connective tissue diseases
Initial evaluation of patients in clinical situations in which the prevalence of disease is low (6)
This test is not recommended for:
-Testing in clinical situations in which there is a high prevalence of connective tissue diseases (eg, rheumatology specialty practice)
-Follow-up evaluation of patients with known connective tissue diseases
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| ANA2 | Antinuclear Ab, S | Yes | Yes |
| CCP | Cyclic Citrullinated Peptide Ab, S | Yes | Yes |
| IM_01 | Interpretation | No | Yes |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| CMA | Centromere Ab, IgG, S | Yes | No |
| CASMT | ANA2 Cascade | No | No |
| RIB | Ribosome P Ab, IgG, S | Yes | No |
| ENAE | Ab to Extractable Nuclear Ag Eval,S | Yes | No |
| ADNA1 | dsDNA Ab, IgG, S | Yes | No |
Testing Algorithm
If antinuclear antibodies are greater than or equal to 3.0 U, then antibodies to double-stranded DNA (dsDNA), extractable nuclear antigen evaluation, ribosome P, and centromere are performed at an additional charge.
For more information see Connective Tissue Disease Cascade.
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
SerumSpecimen Required
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Information: Centrifuge and aliquot serum into plastic vial.
Specimen Minimum Volume
0.7 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum | Refrigerated (preferred) | 21 days |
| Frozen | 21 days |
Special Instructions
Reference Values
ANTINUCLEAR ANTIBODIES (ANA)
≤1.0 U (Negative)
1.1-2.9 U (Weakly positive)
3.0-5.9 U (Positive)
≥6.0 U (Strongly positive)
Reference values apply to all ages.
CYCLIC CITRULLINATED PEPTIDE ANTIBODIES, IgG
<20.0 U (Negative)
20.0-39.9 U (Weak positive)
40.0-59.9 U (Positive)
≥60.0 U (Strong positive)
Reference values apply to all ages.
Day(s) Performed
Monday through Saturday
Test Classification
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.CPT Code Information
86038
86200
83516-Centromere (if appropriate)
83516-Ribosome (if appropriate)
86225-ds-DNA AB IgG, Serum (if appropriate)
86235 x 6-RNP, Sm, SS-B, SS-A, Jo 1, and Scl 70 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| CTDC | Connective Tissue Disease Cascade,S | 95267-1 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| ANA2 | Antinuclear Ab, S | 94875-2 |
| CCP | Cyclic Citrullinated Peptide Ab, S | 33935-8 |
| IM_01 | Interpretation | 69048-7 |
Interpretation
Interpretive comments are provided.
Differential testing for Ro52 and Ro60 antibodies in SS-A/Ro positive patients may be useful in the diagnosis of specific CTD clinical subset, disease stratification, and prognosis. Consider testing for Ro52 and Ro60 antibodies (ROPAN / Ro52 and Ro60 Antibodies, IgG, Serum) if the patient is positive for SS-A/Ro.
Clinical Reference
1. Jog NR, James JA. Biomarkers in connective tissue diseases. J Allergy Clin Immunol. 2017;140(6):1473-1483
2. Pisetsky DS. Annals of the rheumatic diseases collection on autoantibodies in the rheumatic diseases: new insights into pathogenesis and the development of novel biomarkers. Ann Rheum Dis. 2023; 82(10):1243-1247
3. Bossuyt, X., De Langhe, E., Borghi, M.O. et al. Understanding and interpreting antinuclear antibody tests in systemic rheumatic diseases. Nat Rev Rheumatol. 2020;16(12):715-726
4. Stinton LM, Fritzler MJ. A clinical approach to autoantibody testing in systemic autoimmune rheumatic disorders. Autoimmun Rev. 2007;7(1):77-84
5. Anaparti V, Smolik I, Meng X, et al. Expansion of Alternative Autoantibodies Does Not Follow the Evolution of Anti-Citrullinated Protein Antibodies in Preclinical Rheumatoid Arthritis: An Analysis in At-Risk First Degree Relatives. Arthritis Rheumatol. 2021;73(5):740-749. doi:10.1002/art.41675
6. Aletaha D, Neogi T, Silman AJ, et al: 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010 ;62:2569-2581.
7. van den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: An American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum. 2013;65(11):2737-2747. doi:10.1002/art.38098
8. Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheumatol. 2019; 71(9):1400-1412. 3
9. Deng X, Peters B, Ettore MW, et al: Utility of antinuclear antibody screening by various methods in a clinical laboratory patient cohort. J Appl Lab Med. 2016;1(1):36-46
10. Orme ME, Andalucia C, Sjölander S, Bossuyt X. A comparison of a fluorescence enzyme immunoassay versus indirect immunofluorescence for initial screening of connective tissue diseases: Systematic literature review and meta-analysis of diagnostic test accuracy studies. Best Pract Res Clin Rheumatol. 2018; 32(4):521-534
Report Available
3 to 4 daysMethod Name
Enzyme-Linked Immunosorbent Assay (ELISA)