Test Code CTDCS Connective Tissue Disease Cascade, Serum
Epic Test ID
Bronson Laboratory Services-Chemistry/Immunochemistry
See individual test listings for reference values.
See Connective Tissue Disease Cascade Algorithm in
Connective tissue diseases (CTDs) are a heterogeneous group
systemic autoimmune diseases characterized by abnormal structure or
function of 1 or more elements of connective tissue (ie, collagen,
elastin, or mucopolysaccharides). Differential diagnosis of CTDs is
mainly based on clinical findings, but is complicated by the
similarity of their symptoms. Therefore, antibodies to extractable
nuclear antigens are useful markers to support the diagnosis or
exclusion of CTDs.
The most prominent CTDs are systemic lupus erythematosus
(SLE)—potentially affecting all organs; Sjogren’s
Syndrome (SS)—characterized by diminished lacrimal and
salivary gland secretions; scleroderma (systemic sclerosis
[SSc])—a chronic, progressive dermatosis; limited systemic
sclerosis—a scleroderma also known as CREST syndrome with a
more benign disease course; poly-dermatomyositis (PM/DM)—an
acute or chronic inflammatory disease of muscle and skin; and mixed
connective tissue disease (MCTD)—a syndrome with features of
scleroderma, rheumatoid arthritis, SLE, and PM/DM.
The presence and specificity of certain autoantibodies gives
strong indication as to the likely CTD involved. The prevalence of
marker autoantibodies in particular CTDs are summarized below.
Primary biliary cirrhosis
Antinuclear Antibody (ANA)
|Cyclic Citrullinated Peptide
Specimen Transport Temperature
Specimen Type: Serum
Container/Tube: Gold top serum
red-top tube is also acceptable.
Specimen Volume: 2 mL
Specimen Minimum Volume: 0.8 mL
Day(s) Test Set Up
Monday through Friday
Test Classification and CPT Coding
If Connective Tissue Disease Cascade ANA is positive at greater than or equal to 1:160, Double Stranded DNA and ENA Screen are reflexed.
If the ENA Screen is positive, the ENA Panel (ENAPNL) is reflex ordered.