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Revista Cubana de Medicina
On-line version ISSN 1561-302X
Abstract
KOKUINA, Elena et al. Optimization of the diagnostic algorithm of antinuclear antibodies. Rev cubana med [online]. 2018, vol.57, n.4 Epub Jan 01, 2019. ISSN 1561-302X.
Introduction:
The antinuclear antibody test is a powerful tool for diagnosing rheumatic diseases. Antinuclear antibodies are determined in the laboratory by an algorithm or sequence that starts with a screening test and continues with the identification of the most common antinuclear specificities. But how to interpret the discordant results between the two levels of study of antinuclear antibodies?
Objective:
To determine the less frequent antinuclear specificities in positive patients of ANA screening and negative of the most common specificities.
Methods:
A prospective study was done on 88 consecutive patients referred for the routine ANA screening with a positive result of screening by enzyme-linked immunosorbent assay (ELISA) but negative for anti-double-stranded DNA (dc, IgG) and common extractable anti-nuclear antigens (ENAc). The corresponding serum samples were evaluated by indirect immunofluorescence on human laryngeal epidermoid carcinoma cells (IFI-HEp-2) and by ELISA for the individual detection of specific ANA.
Results:
The ANA test by IFI / HEp-2 was positive in 56/88 (63.6 %) and the antinuclear specificities were detected in 57/88 (64.8 %) samples, in decreasing Anti-Nucs order: 16/88 (18.2 %); anti-centromere (CENP-B): 15/88 (17.0 %); -histona: 15/88 (17 %); -PM / Scl: 13/88 (14.8 %); -ADNsc: 11/88 (12.5 %) and -ENAc individual: 8/88 (9.1 %). The sensitivity of IFI-HEp-2 for antinuclear specificities was 0.83 (95 % CI: 0.72-0.93). No history of rheumatic disease associated with ANA was read in (26/31) 83.9 % patients with negative subserology.
Conclusions:
The majority of patients with discordant results between the first and second level of ANA were positive of less common antinuclear specificities, but of recognized diagnostic value.
Keywords : Antinuclear antibodies; anti-histone; anti-DNA single chain (anti-ssDNA); anti-nucleosome; anti-PM / Scl; anti-centromere (anti-CENP-B).