Evaluation of Anti-Nuclear antibody test results in clinical practice

Yıl 2015, Cilt: 5 Sayı: 2, 63 - 68, 16.07.2015

Nevreste Çelikbilek , Birsen Özdem Ziya Açıkgöz

https://doi.org/10.5799/ahinjs.02.2015.02.0178

Öz

Objective: Aim of this study is to evaluate anti-nuclear antibody (ANA) test results obtained between 2009 and 2011.

Methods: Of a totally 5068 cases tested for ANA by indirect immunofluorescence method (IIFA), randomly chosen 982 ANA-positive cases were reviewed in terms of gender, level and pattern of fluorescence, anti-dsDNA (anti-double stranded DNA) and anti-extractable nuclear antigen (ENA) profile. Anti-dsDNA levels and anti-ENA profiles were deter­mined by enzyme linked immune assay (ELISA) and immune-blotting (IB), respectively.

Results: Sex distribution of ANA positive patients was determined as 756 (77%) females and 226 (23%) males. Fifty per cent of the cases were from rheumatology department, 20% from gastroenterology and 30% from other units. Fluo­rescence levels were considered borderline or weak positive in 62.6% of the samples. The most frequent patterns were homogeneous (23%), speckled (22%), homogeneous-speckled (15.5%) and nucleolar (13.5%). Anti-dsDNA were studied in 759 ANA positive patients and 66 (8.7%) samples were found positive, being 44 of them (68.8%) with homogeneous pattern and the rest with speckled, nucleolar, nuclear dots, centromeric or midbody patterns. Totally 131 (31.6%) of 414 samples studied for anti-ENA profile were found positive. The first four frequent profiles were SSA (34.4%), SSA-SSB (16.8%), Scl70 (16%) and Sm/RNP (9.2%).

Conclusion: Our results are similar with the current related literature. It is known that autoantibodies can be detectable before clinical symptoms being apparent, especially in SLE. Therefore, borderline or weak fluorescence levels should also be reported and the patients having them should be followed-up carefully. J Microbiol Infect Dis 2015;5(2): 63-68

Key words: Antinuclear antibody, indirect immune-fluorescence assay, extractable nuclear antigen antibodies

Anahtar Kelimeler

Antinuclear antibody, indirect immune-fluorescence assay, extractable nuclear antigen antibodies

Kaynakça

• Yılmaz Ö, Karaman M, Ergon MC, ve ark. Konnektif doku hastalıklarını
• tanısında Antinükleer (ANA) ve Anti-double stranded DNA (anti-dsDNA) antikorlarının önemi. T Parazitol Derg 2005;29:287-290.
• Yumuk Z, Çalışkan Ş, Gündeş S, Willke A. Anti-nükleer antikorların
• araştırılması ve saptanmasında kullanılan teknikler. Türk Mikrobiyol Cem Derg 2005;35:40-44.
• Afşar İ, Şener AG, Vural A, ve ark. Anti nükleer antikorların pozitif
• saptandığı hastalarda immunoblotting test sonuçlarının değerlendirilmesi. Türk Mikrobiyol Cem Derg 2007;37:39-42.
• Kumar Y, Bhatia A, Minz RW. Antinuclear antibodies and their detection methods in diagnosis of connective tissue diseases: a journey revisited. Diagnostic Pathol 2009; 4:1. Available from: http://www.diagnosticpathology.org/content/4/1/1.
• Agmon-Levin N, Damoiseaux J, Kallenberg C, et al. International
• recommendations for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies. Ann Rheum Dis 2014;73:17-23.
• Greidinger EL, Hoffman RW. Antinuclear antibody testing:methods, indications, and interpretation. doi: 10.1309/VUB-90VTPMEWV3W0FLabMedicine 2003;34:113-117.
• Avaniss-Aghajani E, Sophia B, Sarkissian A. Clinical value of multiplexed bead-based immunoassays for detection of autoantibodies to nuclear antigens. Clin Vaccine Immunol 2007;14:505-509.
• Güdücüoğlu H, Yaman G, Çıkman A, et al. Retrospective evaluation of immunoblotting (IB) test results in anti-nuclear antibody positive patients. Turkish J Clin Lab 2011;2:59-62.
• Li Q, Karp D, Quan J, et al. Risk factors for ANA positivity in healthy persons. Artritis Res Ther 2011;13:R38.
• Lleo A, Battezzati PM, Semli C, et al. Is autoimmunity a matter of sex? Autoimmun Rev 2008;7:626-630.
• Karakeçe E, Atasoy AR, Çakmak G, ve ark. Bir üniversite hastanesinde antinükleer antikor pozitiflikleri. Turk J Immunol 2014;2:5-8.
• Habash-Besaiso D, Yale S, Glurich I, Goldberg J. Serologic testing in connective tissue disorders. Clin Med and Research 2005;3:190-193.
• Ardeniz Ö. Otoimmün karaciğer hastalıklarında antinükleer antikorların değerlendirilmesi ve klinik uygulamadaki yeri. Güncel Gastroenteroloji 2006;10:187-192.
• Aydemir S, Tekin İ, Engin H, ve ark. Non alkolik steatohepatitli hastalarda antinükleer antikor prevalansı ve önemi. Akademik Gastroenteroloji Dergisi 2005;4:158-161.
• Yumuk Z, Sayan M, Çalışkan Ş. Kronik hepatit C hastalarında otoantikorların HCV RNA düzeyi ile ilişkisi. İnfeksiyon Derg 2008;22:29-34.
• Ulvestad E, Kanestrom A, Madland TM, et al. Evaluation of diagnostic tests for antinuclear antibodies in rheumatological practise. Scand J Immunol 2000;52:309-15.
• Keren D. Guidelines for the Clinical Use of ANA and Related Specific Autoantibody Testing. Article Archives 2000;11:2.
• Mariz H, Sato E, Barbosa S, et al. Pattern on the antinuclear antibody-Hep-2 test is a critical parameter for discriminating antinuclear antibody-positive healthy individuals and patientswith autoimmune rheumatic diseases. Arthritis Rheum2011;63:191-200.
• Hurme M, Korkki S, Lehtimaki T, et al. Autoimmunity and longevity: presence of antinuclear antibodies is not associated with the rate of inflammation or mortality in nonagerians.Mech Ageing Dev 2007;128:407-408.
• Arbuckle MR, McClain MT, Rubertone MV, et al. Development of autoantibodies before the clinical onset of systemic lupus erithematosus. N Engl J Med 2003;349:1526-1533.
• Yumuk Z, Çalışkan Ş. Evaluation of diagnostic autoantibody tests used in clinical laboratories. Türk Mikrobiyol Cem Derg 2008;38:37-41.
• Ganapathy V, Casiano CA, Autoimmunity to the nuclear autoantigen
• DFS70 (LEDGF): what exactly are the autoantibodies trying to tell us? Arthritis Rheum 2004;50:684-688.
• Watanabe A, Kodera M, Sugiara K, et al. Anti-DFS70 antibodies in 597 healthy hospital workers. Arthritis Rheum 2004;50:892-900.
• Hughes R, Ul-Hassan S. Anti-dsDNA antibodies: their role in the detection and monitoring of SLE. CLI 2006;7:12-17.
• Biesen R, Dahnrich C, Rosemann A, et al. Anti-dsDNA-NcX ELISA: dsDNA-loaded nucleosomes improve diagnosis and monitoring of disease activity in systemic lupus erythematosus.Arthritis Res Ther 2011;13:R26.
• Ece A, Şahin C. Çocuk romatolojisi pratiğinde laboratuar testlerinin
• kullanımı. J Clin Exp Invest 2013;4:258-261.
• Tanyel T, Tutkak H, Önen I, Laleli Y. Düzen laboratuarına başvuran ANA pozitif hastalarda gözlenen paternlerin sıklı-ğı. Proceedings of the 33. Türk Mikrobiyoloji Kongresi Kitabı;Ekim 21-25, 2008; Bodrum, Türkiye; 2008.p.823.P170.
• Gonzalez C, Guevara P, Alarcon I, et al. Antinuclear antibodies (ANA) screening by enzyme immunoassay with nuclear Hep-2 cell extract and recombinant antigens: analytical and clinical evaluation. Clin Biochem 2002;35:463-469.
• Verstegen G, Duyck MC, Meeus P, et al. Detection and identification
• of antinuclear antibodies (ANA) in a large community hospital. Acta Clin Belg 2009;64:317-323.
• Birtane M, Diagnostic role of anti-nuclear antibodies in rheumatic
• diseases. Turk J Rheumatol 2012;27:79-89.
• Hoffman IEA, Peene I, Veys EM, De Keyser F. Detection of specific antinuclear reactivities in patients with negative antinuclear antibody immunofluorescence screening tests. Clinical Chemistry 2002;48:2171-2176.
• Cabiedes J, Núñez-Alvarez CA. Antinuclear antibodies. Reumatol
• Clin2010;6:224-230.