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Revista Cubana de Medicina

versão impressa ISSN 0034-7523versão On-line ISSN 1561-302X


KOKUINA, Elena et al. Optimization of the diagnostic algorithm of antinuclear antibodies. Rev cubana med [online]. 2018, vol.57, n.4, e403.  Epub 01-Jan-2019. ISSN 0034-7523.


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?


To determine the less frequent antinuclear specificities in positive patients of ANA screening and negative of the most common specificities.


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.


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.


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.

Palavras-chave : Antinuclear antibodies; anti-histone; anti-DNA single chain (anti-ssDNA); anti-nucleosome; anti-PM / Scl; anti-centromere (anti-CENP-B).

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