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Interstitial lung disease can be the first sign of systemic autoimmune disease. If associated with myositis, interstitial lung disease may be the only symptom, with no presence of muscular weakness or other extramuscular manifestations. ANA-testing performed with indirect immune fluorescence may be negative. Testing for myositis antibodies should be considered as a step in the diagnostic process when strong clinical suspicion of interstitial lung disease of unknown origin is present. If interstitial lung disease is suspected, the patients should be referred to a specialist clinic for further investigation and, if possible, for discussion within a multidisciplinary team. Early suspicion of systemic inflammatory disease, rapid diagnosis and early start of treatment are crucial for future prognosis, quality of life and survival.

Antibodies directed against citrullinated proteins (anti-CP) constitute a newly defined group of autoantibodies with very high diagnostic specificity for rheumatoid arthritis (RA). The most recently developed assays have a sensitivity comparable to that of traditional tests for Rheumatoid Factor (RF). Due to its considerably higher specificity, the authors recommend that anti-CP antibody analysis should replace the RF test in primary healthcare when investigating cases of clinically suspect RA.