The following guideline presents a series of recommendations based on published medical literature for use of the antinuclear antibody (ANA) test and tests for specific autoantibodies to nuclear antigens in the diagnostic evaluation, prognostic assessment, and monitoring of patients with systemic rheumatic diseases. The guideline emphasizes the need for clinical evaluation to improve the usefulness of test results in patient management. Consideration is given to appropriate use of the generic ANA test in the initial evaluation of patients with signs and symptoms of a systemic rheumatic disease, the evaluation of patients suspected of having lupus erythematosus, use in clinical situations in which the ANA test is required to establish a disease diagnosis, and identification of clinical situations in which the ANA test has little value. Sections are also devoted to recommendations aimed at improving the analytic methods used to detect and measure ANA and specific autoantibodies to nuclear antigens and to the appropriate use of tests for specific autoantibodies in several disease situations that commonly occur in patients with suspected or documented systemic rheumatic diseases. Emphasis is placed on the use of these tests only in situations in which the test results can be expected to provide information necessary for clinical decision making. Those tests of limited medical usefulness and situations in which test results are likely to be misleading are also identified.

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Levamisole, an anthelminthic agent with immunostimulatory properties, was used in a double-blind, controlled therapeutic trial in rheumatoid arthritis. Patients received either levamisole 100 mg 4 days a week, or placebo, for a period of 4 months. Significant improvement in the treated group, as compared with the control group, was found in the number of tender and swollen joints, grip strength, range of joint motion, sedimentation rate, and C-reactive protein. On double-blind global evaluation by the examining physicians, 9 of 14 patients on levamisole and none of 13 on placebo were considered to have improved. Adverse effects did not differ in frequency between the two groups except for mild alteration in taste, which was more common with levamisole. (2,3). contrasting with the suppressive effects of corticosteroids (4) and cytotoxic agents (5). We have performed a double-blind, placebo-controlled trial, which demonstrates that levamisole produces significant shortterm improvement in patients with rheumatoid arthritis. PATIENTS AND METHODSThirty patients with definite or classic rheumatoid arthritis, as defined by the criteria o f the American Rheumatism Association, entered the study with informed consent and were assigned at random to receive identical tablets containing either levamisole 100 mg, or placebo, on 4 consecutive days per week. None of the patients received gold or corticosteroids within 5 months before the trial. All were considered to have active disease and were receiving salicylates and other nonsteroidal antiinflammatory agents, which were continued in the same doses during the study.Assessments were performed on two occasions, 2 days apart, at the beginning and end of the 16-week study period, and at 4-week intervals during the trial, always by the same physician. The measurements included a determination of the number of tender and swollen joints, the number and size of rheumatoid nodules, grip strength, 50-foot walking time, duration of morning stiffness, Westergren sedimentation rate (ESR), and C-reactive protein (CRP). Routine hematologic studies and chemical profile were performed monthly. The range of joint motion, rheumatoid factor by the latex fixation method and skin testing with streptokinase-streptodornase, PPD, candida, and mumps antigens were recorded at the

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