# Prevalence and clinical associations of anti-rods and rings antibodies in ANA-tested patients

## TL;DR

This study examines the prevalence and clinical significance of anti-rods and rings antibodies in a large Turkish patient group, finding they are rare and linked to various conditions beyond hepatitis C.

## Contribution

The study provides new insights into the clinical associations of anti-RR antibodies in a large cohort, highlighting their occurrence in diverse diseases.

## Key findings

- Anti-RR antibodies were found in 0.16% of ANA-tested patients, predominantly in females aged around 52.
- Anti-RR antibodies were associated with autoimmune diseases, nephropathic, hepatic, and pulmonary conditions.
- Anti-RR positivity showed no significant link to classical ANA-specific autoantibodies.

## Abstract

Anti-rods and rings (anti-RR) antibodies represent a rare cytoplasmic antinuclear antibody (ANA) pattern typically associated with hepatitis C virus (HCV) infection and interferon-based therapy. However, emerging evidence suggests a broader clinical relevance beyond HCV. This study aimed to investigate the prevalence, immunofluorescence characteristics, autoantibody associations, and clinical contexts of anti-RR antibodies in a large Turkish patient cohort undergoing routine ANA screening. Serum samples were retrospectively analysed for ANA using indirect immunofluorescence (IIF) between January 2022 and October 2024. Samples displaying anti-RR patterns were further evaluated for specific ANA profiles using line immunoassay. Clinical and demographic data were collected from medical records. Among 57,644 patients tested for ANA, 11,752 (20.39%) were ANA-positive, with only 91 cases (0.16%) exhibiting an anti-RR pattern. These cases were predominantly female (60.44%) with a median age of 52 years. Isolated anti-RR patterns were observed in 70.33% of patients, while the remainder showed mixed patterns, most commonly with AC-4,5,31 and AC-1 ANA patterns. Anti-RR positivity showed no significant association with classical ANA-specific autoantibodies. Clinically, anti-RR-positive patients displayed diverse diagnoses, including autoimmune diseases (21.98%), nephropathic conditions (9.89%), hepatic (7.69%) and pulmonary (6.59%) disorders, with the majority (53.85%) categorized under other conditions. Anti-RR antibodies, while rare, occur across a spectrum of diseases and may be associated with heterogeneous clinical conditions beyond hepatitis C infection. Their detection warrants careful interpretation within the appropriate clinical and laboratory context. Prospective studies are needed to explore their pathophysiological roles and diagnostic utility in diverse patient populations.

The online version contains supplementary material available at 10.1007/s12026-026-09754-6.