The presentations and outcomes of patients with positive ANA test
Keywords:
Anti-nuclear antibody, connective tissue diseaseAbstract
Background: In general practice, antinuclear antibody (ANA) test is often used as an initial screening for connective tissue diseases (CTDs). Even though positive test can be detected in most of the autoimmune diseases, it can also be found in other inflammatory or infectious conditions, and even in healthy individuals. Objective: To evaluate the patients who had positive antinuclear antibody (ANA) test in relation to clinical presentation and presence of connective tissue diseases (CTDs). Methods: A retrospective collection of data was done in patients who underwent the ANA test at Phramongkutklao Hospital between May 1, 2013 and March 30, 2015. Patients older than 15 years old with ANA titer ≥1:160 were enrolled into the study. The demographic data, clinical presentations, relevant laboratory evaluations and final diagnosis were collected. Results: There were 320 patients, 59 were male and 261 were female with the mean age of 48.5 years. The final diagnoses of connective tissue diseases (CTD) and non-connective tissue diseases (non-CTD) were found in 154 (48.12%) and 166 (51.88%) of patients respectively. ANA patterns of “homogeneous”, “coarse speckled” and “nucleolar”, especially in high titer (≥1:1280) were significantly correlated with the diagnosis of CTD (P< 0.05). No correlation of ANA patterns and major organ involvement was found. Nevertheless, the presence of anti-centromere pattern was associated with less number of major organ involvements. Conclusion: Among patients with positive ANA test, the patients with high titers of “homogeneous”, “speckled” and “nucleolar” ANA patterns were more likely to have CTDs. The presence of anti-centromere pattern was less likely to have major organ involvement.
References
2. Abeles AM, Abeles M. The Clinical Utility of a Positive Antinuclear Antibody test Result. Am J Med 2013; 126: 342-8.
3. Wichainun R, Kasitanon N, Wangkaew S, et al. Sensitivity and specificity of ANA and anti-dsDNA in the diagnosis of systemic lupus erythematosus: A comparison using control sera obtained from healthy individuals and patients with multiple medical problems. Asian Pac J Allergy Immunol 2013; 31: 292- 8.
4. Wang KY, Yang YH, Chuang YH, et al. The initial manifestations and final diagnosis of patients with high and low titers of antinuclear antibodies after 6 months of follow-up. J Microbiol Immunol Infect 2011; 44: 222-8.
5. Narain S, Richards HB, Satoh M, et al. Diagnostic accuracy for lupus and other systemic autoimmune diseases in the community setting. Arch Intern Med 2004; 164: 2435-2441.
6. Slater CA, Davis RB, Shmerling RH. Antinuclear Antibody Testing. A study of clinical utility. Arch Intern Med 1996; 156: 1421-1425.
7. Moulias R, Proust J, Wang A, et al. Age-related increase in autoantibodies. Lancet 1984; 1: 1128-9.
8. Bertsias G, Cervera R, Boumpas D. Systemic lupus erythematosus: pathogenesis and clinical features. In: Bijlsma J, editor. EULAR textbook on rheumatic diseases. London: BMJ Group; 2012. pp. 476–505.
9. Dijkstra S, Nieuwenhuys EJ, Swaak AJ. The prognosis and outcome of patients referred to an outpatient clinic for rheumatic disease characterized by the presence of antinuclear antibodies (ANA). Scand J Rheumatol 1999; 28: 33-7.
10. Wijeyesinghe U, Russell AS. Outcome of high titer antinuclear antibody positivity in individuals without connective tissue disease: a 10-year follow-up. Clin Rheumatol 2008; 27: 1399–1402.
11. Sontheimer RD, Hansen CB, Costner MI. Dermatomyositis. In: Goldsmith LA, Katz SI, Gilchrest BA, Pallwr AS, Leffell DJ, Wolff K, editors. Fitzpatrick’s dermatology in general medicine. 8th ed. New York:McGraw Hill;2012.1926-42.
12. Moinzadeh P, Denton CP, Krieg T, Black CM. Scleroderma. In: Goldsmith LA, Katz SI, Gilchrest BA, Pallwr AS, Leffell DJ, Wolff K, editors. Fitzpatrick’s dermatology in general medicine. 8th ed. New York:McGraw Hill;2012.1942-56.
13. Handa R. Management of Systemic Lupus Erythematosus. In: Joshi SR, editor. Medicine Update 2007. 24th ed. Shah SN. Publisher Association of Physicians of India, Bombay 2007; 839-44.
14. Hashimoto H. Glucocorticoid Therapy in systemic lupus erythematosus-clinical analysis of 1,125 Patients with SLE. In: Qian X, editor. GlucocorticoidNew Recognition of our Familiar Friend. 1st ed. In Tech 2012; 481-500.
15. Tan EM, Feltkamp TE, Smolen JS, Butcher B, Dawkins R, Fritzler M, et al. Range of antinuclear antibodies in healthy individuals. Arthritis Rheum 1997; 40: 1601- 13.
16. Wichainun R, Kasitanon N, Wangkaew S, Hongsongkiat S, Sukitawut W, Louthrenoo W. Sensitivity and specificity of ANA and anti-dsDNA in the diagnosis of systemic lupus erythematosus: A comparison using control sera obtained from healthy individuals and patients with multiple medical problems. Asian Pac J Allergy Immunol 2013; 31: 292-8.
17. Solomon DH, Kavanaugh AJ, Schur PH. Evidencebased guidelines for the use of immunologic tests: Antinuclear antibody testing. Arthritis Rheum 2002, 47: 434-444.
18. Owlia MB. Clinical spectrum of connective tissue disorders. JIACM 2006; 7: 217-224.
19. Castro C, Gourley M. Diagnostic Testing and Interpretation of Tests for Autoimmunity. J Allergy Clin Immunol 2010; 125: s238–247.
20. Mariz HA, Sato EI, Barbosa SH, et al. Pattern on the antinuclear antibody–HEp-2 test is a critical parameter for discriminating antinuclear antibody– positive healthy individuals and patients with autoimmune rheumatic diseases. Arthritis Rheum 2011; 63: 191–200.
21. Frodlund M, Dahlstrom O, Kastbom A, Skogh T, Sjöwall C. Associations between antinuclear antibody staining patterns and clinical features of systemic lupus erythematosus: analysis of a regional Swedish register. BMJ Open 2013; 3: 1-8.
22. Patsinakidis N, Gambichler T, Lahner N, Moellenhoff K, Kreuter A. Cutaneous characteristics and association with antinuclear antibodies in 402 patients with different subtypes of lupus erythematosus. J Eur Acad Dermatol Venereol 2016; 30: 2097–2104.
23. Zaid FE, Abudsalam N. Cutaneous Manifestation of Systemic Lupus Erythematosus [SLE], Correlation with Specific Organ Involvement, Specific Auto Antibodies and Disease Activity and Outcome. Dermatology Case Reports 2016;1:108
24. Hesselstrand R, Scheja A, Shen GQ, Wiik A, Akesson A. The association of antinuclear antibodies with organ involvement and survival in systemic sclerosis. Rheumatology (Oxford) 2003; 42: 534–540.
25. Tangri V, Hewson C, Baron M, Bonner A, Fritzler M, Pope JE. Associations with organ involvement and autoantibodies in systemic sclerosis: results from the canadian scleroderma research group (CSRG). Open Journal of Rheumatology and Autoimmune Diseases 2013; 3: 113-118.
26. Habash-Bseiso DE, Yale SH, Glurich I, Goldberg JW. Serologic testing in connective tissue diseases. Clin Med Res. 2005; 3(3): 190–193.
27. Zandman-Goddard G, Gilburd B, Shovman O, et al. The homogeneous multiplexed system–a new method for autoantibody profile in systemic lupus erythematosus. Clin Dev Immunol 2005; 12: 107–111.
28. Zhan L, Wu G, Gao D, et al. Factors associated with interstitial lung disease in patients with polymyositis and dermatomyositis: A systematic review and metaanalysis. PLoS One 2016; 11: 1-15.
29. McCarty GA, Rice JR, Bembe ML, Barada FA Jr. Anticentromere antibody. Clinical correlations and association with favorable prognosis in patients with scleroderma variants. Arthritis Rheum 1983; 26:1-7.
30. Chung L, Utz PJ. Antibodies in scleroderma: direct pathogenicity and phenotypic associations. Curr Rheumatol Rep 2004; 6: 156–163.
31. Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012; 64: 2677-86.
32. Cohen RC, Chodick G, Shalev V, et al. Chronic urticaria and autoimmunity: associations found in alarge population study. J Allergy Clin Immunol 2012; 129: 1307-13.
33. Fraser K, Robertson L. Chronic urticaria and autoimmunity. Skin Therapy Lett 2013; 18:5-9.
34. Dalle Vedove C, Simon JC, Girolomoni G. Druginduced lupus erythematosus with emphasis on skin manifestations and the role of anti-TNFα agents. J Dtsch Dermatol Ges 2012; 10: 889-97.
35. Marzano AV, Vezzoli P, Crosti C. Drug-induced lupus: an update on its dermatologic aspects. Lupus 2009; 18: 935-40.
36. Lupu A, Tieranu C, Constantinescu CL, Diculescu M. TNFα inhibitor induced lupus-like syndrome (TAILS) in a patient with IBD. Curr Health Sci J 2014; 40: 285-8.
37. Antonov D, Kazandjie AJ, Etugov D, Gospodinov D, Tsankov N. Drug-Induced lupus erythematosus. Clinics in Dermatol 2004; 22: 157–166.
Downloads
Published
How to Cite
Issue
Section
License
เนื้อหาและข้อมูลในบทความที่ลงตีพิมพ์ในวารสารโรคผิวหนัง ถือเป็นข้อคิดเห็นและความรับผิดชอบของผู้เขียนบทความโดยตรงซึ่งกองบรรณาธิการวารสาร ไม่จำเป็นต้องเห็นด้วย หรือร่วมรับผิดชอบใดๆ
บทความ ข้อมูล เนื้อหา รูปภาพ ฯลฯ ที่ได้รับการตีพิมพ์ในวารสารโรคผิวหนัง ถือเป็นลิขสิทธิ์ของวารสารฯ หากบุคคลหรือหน่วยงานใดต้องการนำทั้งหมดหรือส่วนหนึ่งส่วนใดไปเผยแพร่ต่อหรือเพื่อกระทำการใดๆ จะต้องได้รับอนุญาตเป็นลายลักอักษรจากบรรณาธิการวารสารโรคผิวหนังก่อนเท่านั้น
