@hamzaw the ANA with reflex panel may be different from the testing you have had. NOt sure. But after 25 years of the usual testing I recently was discovered to have very high centromere antibodies, and this was the first time I had seen tests for that. From Quest regarding the ANA with reflex panel:

Test Details
Includes
ANA Screen, IFA, with Reflex to Titer and Pattern
DNA (ds) Antibody, Crithidia IFA with Reflex to Titer
Chromatin (Nucleosomal) Antibody
Sm Antibody
Sm/RNP Antibody
RNP Antibody
Sjogren's Antibodies (SS-A, SS-B)
Scleroderma Antibody (Scl-70)
Jo-1 Antibody
Centromere B Antibody
Complement Component C3c and C4c
Cardiolipin Antibodies (IgA, IgG, IgM)
Beta-2-Glycoprotein I Antibodies (IgG, IgA, IgM)
Rheumatoid Factor (IgA, IgG, IgM)
Cyclic Citrullinated Peptide (CCP) Antibody (IgG)
Mutated Citrullinated Vimentin (MCV) Antibody
Thyroid Peroxidase Antibodies (TPO)

If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge (CPT code(s): 86039).

If the DNA (ds) Antibody Screen is positive, then DNA (ds) Antibody Titer will be performed at an additional charge (CPT code(s): 86256).

If you do the Quest ANA lab with titer and reflex, you will get ICAP's (International Consensus on ANA Patterns) AC codes. These codes represent general consensus on certain patterns and what they represent. My AC codes indicated systemic sclerosis, primarily. None of the ENA antibodies cover that. I had indications of systemic sclerosis (scleroderma), systemic sclerosis/polymyositis overlap, MCTD, SLE and Sjogren's syndrome. Only the latter two might be covered by ENA.

It is lazy for a rheumatologist not to bother to get those AC codes. They can be very important.