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Algorithm for antinuclear antibodies in subjects with clinical suspicion of autoimmune diseases

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12

 

  1. Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, Spain, and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
  2. Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
  3. Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, Spain, and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
  4. Immunology and Allergy Laboratory, San Giovanni di Dio Hospital, Azienda USL Toscana Centro, Firenze, Italy.
  5. Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, Spain.
  6. Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain.
  7. Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
  8. Immunology and Allergy Laboratory, San Giovanni di Dio Hospital, Azienda USL Toscana Centro, Firenze, Italy.
  9. Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, Spain.
  10. Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain.
  11. Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
  12. Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, Spain. aserrano@h12o.es

CER12384
2020 Vol.38, N°4
PI 0633, PF 0639
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PMID: 31694754 [PubMed]

Received: 02/05/2019
Accepted : 06/08/2019
In Press: 17/10/2019
Published: 28/07/2020

Abstract

OBJECTIVES:
Antinuclear antibodies (ANA) are fundamental in the diagnosis of systemic autoimmune rheumatic diseases (SARDs). Different assays for ANA screening are available, such as indirect immunofluorescence (IIF) on HEp-2 cells and Multiplex fluorescent immunoassay (MFI). This study aimed to clarify the importance of ANA detected only by IIF in the future development of SARDs and to recommend a laboratory algorithm that integrates the available diagnostic approaches to optimise the diagnosis of ANA IIF+MFI- subjects.
METHODS:
A total of 9,291 subjects with clinical suspicion of SARDs were evaluated for ANA by IIF and MFI. One hundred and ninety-eight subjects (2.1%) were ANA IIF+MFI-, who were followed up for 2 years. ANA were evaluated using IIF on HEp-2 cells and MFI on the BioPlex 2200.
RESULTS:
The ANA IIF+MFI- cohort included 106 subjects with SARDs, 26 subject with other autoimmune diseases (not-SARDs) and 66 subjects with minor symptoms or ANA requested in check-ups. Only 94 subjects underwent re-evaluation. After a 2-year follow-up, most re-evaluated subjects (51 patients) became ANA negative for both assays (mainly rheumatoid arthritis, polymyalgia and inflammatory bowel disease patients) and 35 subjects remained ANA IIF+MFI- (principally systemic sclerosis and systemic lupus erythematosus patients). A new algorithm for ANA evaluation was suggested.
CONCLUSIONS:
According to the proposed algorithm, ANA IIF+MFI- subjects should be screened by an alternative solid-phase assay such as line-immunoassay or ELISA.

Rheumatology Article