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      Predictive value of antinuclear antibodies in autoimmune diseases classified by clinical criteria: Analytical study in a specialized health institute, one year follow-up

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          Abstract

          Introduction: Determination of antinuclear antibodies (ANA) by indirect immunofluorescence (IIF) is usually the initial test for the diagnosis of systemic rheumatic diseases (SRD). Assigning predictive values to positive and negative results of the test is vital because lack of knowledge about ANAs and their usefulness in classification criteria of SRD leads to inappropriate use. Methods: Retrospective study, ANA tests requested by different specialties, correlation to patients' final diagnosis. Results: The prevalence of autoimmune disease was relatively low in our population yielding a low PPV and a high NPV for the ANA test. 40% of the patients had no clinical criteria applied prior to test. Coexistence of two or more autoimmune disorders affects prevalence and predictive values. Conclusion: Application of the test after careful evaluation for clinical criteria remarkably improves the positive likelihood ratio for the diagnosis.

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          Neuromyelitis optica and non organ-specific autoimmunity.

          Brian G. Weinshenker, K G Moder, Claudia Lucchinetti … (2007)
          Neuromyelitis optica (NMO) is often associated with other clinical or serological markers of non-organ-specific autoimmunity. To evaluate the relationship between NMO spectrum disorders (NMOSDs), including NMO, longitudinally extensive transverse myelitis, and recurrent optic neuritis, and autoimmune disease. We concentrated on the association with systemic lupus erythematosus (SLE), Sjögren syndrome (SS), or serological evidence of these disorders, which commonly is a source of diagnostic confusion. Retrospective blinded serological survey. Mayo Clinic College of Medicine, Rochester, and Centre Hospitalier Régional Universitaire de Lille. Group 1 included 153 US patients with NMOSDs (78 with NMO and 75 with longitudinally extensive transverse myelitis) and 33 control subjects with SS/SLE. Group 2 included 30 French patients with SS/SLE, 14 with NMOSDs (6 with NMO, 6 with longitudinally extensive transverse myelitis, and 2 with recurrent optic neuritis), 16 without NMOSDs, and 4 with NMO without SS/SLE. For group 1, NMO-IgG was detected in 66.7%, antinuclear antibodies in 43.8%, and Sjögren syndrome A (SSA) antibodies in 15.7% of patients with NMO and longitudinally extensive transverse myelitis. Five NMO-IgG-seropositive patients with NMOSDs had coexisting SLE, SS, or both. Antinuclear antibodies and SSA antibodies were more frequent in NMO-IgG-seropositive patients than in NMO-IgG-seronegative patients (P= .001). For group 2, NMO-IgG was detected in 5 of 14 patients (35.7%) with NMOSDs and SS/SLE and in 2 of 4 patients (50.0%) with NMO without SS/SLE (P= .59). We detected NMO-IgG only in patients with NMOSDs and not in 49 controls with SS/SLE but without optic neuritis or myelitis from the 2 cohorts (P= .01). Neuromyelitis optica spectrum disorders with seropositive findings for NMO-IgG occurring with SS/SLE or non-organ-specific autoantibodies is an indication of coexisting NMO rather than a vasculopathic or other complication of SS/SLE.
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            Guidelines for the laboratory use of autoantibody tests in the diagnosis and monitoring of autoimmune rheumatic diseases.

            Elio Tonutti, F Manoni, Nicola Bizzaro … (2002)
            The Italian Society of Laboratory Medicine Study Group on the Diagnosis of Autoimmune Diseases has generated a series of guidelines for the laboratory diagnosis and monitoring of systemic autoimmune rheumatic diseases intendedfor the use of clinical pathologists and laboratory physicians. These guidelines are based on a systematic review of published works and expert panel discussion and consist of 13 recommendations for antinuclear antibodies, anti-double-stranded native DNA, and antinuclear specific antibodies. To improve analytic performances and help select the most appropriate test for specific autoantibodies, as well as provide education and guidance in the use of these tests, special emphasis is placed on laboratory methods.
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              Autoantibody profiles in systemic sclerosis: predictive value for clinical evaluation and prognosis.

              Yasuhito Hamaguchi (2009)
              Systemic sclerosis (SSc) is thought to be an autoimmune disease, as autoantibodies against a variety of extractable nuclear antigens can be detected in patient sera. Subgrouping patients based on the type of autoantibodies present can be useful in diagnosis and management. Anti-centromere antibodies (ACA) and anti-topoisomerase I antibodies (anti-topo I) are the classic autoantibodies associated with SSc. ACA are associated with limited cutaneous involvement and isolated pulmonary hypertension, whereas anti-topo I are associated with diffuse skin involvement and pulmonary fibrosis. ACA are predictors for a favorable prognosis, while anti-topo I are correlated with a poor prognosis and SSc-related mortality. Additionally, anti-RNA polymerase antibodies (anti-RNAP) are associated with diffuse cutaneous disease and renal involvement. Anti-nucleolar antibodies define multiple subgroups of patients with SSc. Of these, anti-Th/To antibodies (anti-Th/To) and anti-PM-Scl antibodies (anti-PM-Scl) are associated with limited cutaneous SSc (lSSc), whereas anti-U3RNP antibodies (anti-U3RNP) are associated with diffuse cutaneous SSc (dSSc). In addition, anti-Th/To and anti-U3RNP can be predictors for a less favorable prognosis with a higher frequency of organ involvement, such as pulmonary fibrosis, pulmonary hypertension and renal crisis. Other autoantibodies are less frequently reported: anti-Ku antibodies, anti-U1RNP antibodies, anti-human upstream-binding factor, and anti-U11/U12 antibodies. These antibodies are generally less specific to SSc, but also define clinically distinct patient subsets. Thus, characterization of autoantibodies in SSc together with knowledge of disease characteristics intrinsic to distinct patient populations is helpful for assessing the clinical presentation and prognosis of this disease, and for monitoring patients with SSc.
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                Author and article information

                Contributors
                María Elena Soto
                Journal
                Journal ID (nlm-ta): Results Immunol
                Journal ID (iso-abbrev): Results Immunol
                Title: Results in Immunology
                Publisher: Elsevier
                ISSN (Electronic): 2211-2839
                Publication date PMC-release: 09 November 2013
                Publication date Collection: 2015
                Publication date (Electronic): 09 November 2013
                Volume: 5
                Pages: 13-22
                Affiliations
                [a ]Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
                [b ]Universidad Panamericana School of Medicine, Mexico City, Mexico
                [c ]Universidad Nacional Autónoma de México, Faculty of Medicine, Mexico City, Mexico
                [d ]Department of Cardiovascular Magnetic Resonance, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
                [e ]Department of Health Care, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico
                Author notes
                [* ]Correspondence to: Juan Badiano #1, Col. Seccion XVI, Tlalpan 14080, Mexico. mesoto50@ 123456hotmail.com
                Article
                Publisher ID: S2211-2839(13)00017-8
                DOI: 10.1016/j.rinim.2013.10.003
                PMC ID: 4625361
                PubMed ID: 26623249
                SO-VID: 14085ce5-a383-435a-91fc-0e8fa5e06e83
                Copyright © © 2014 The Authors
                License:

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/3.0/).

                History
                Categories
                Subject: Most Recent Article

                Keywords: antinuclear antibodies,generalized rheumatic disease,clinical criteria,predictive value.
                Data availability:
                Keywords: antinuclear antibodies, generalized rheumatic disease, clinical criteria, predictive value.

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