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An evaluation of autoimmune antibody testing patterns in a Canadian health region and an evaluation of a laboratory algorithm aimed at reducing unnecessary testing. Man Ada,Shojania Kam,Phoon Carmen,Pal Jason,de Badyn Monika Hudoba,Pi David,Lacaille Diane Clinical rheumatology Autoantibody tests are often ordered inappropriately. We aimed to evaluate the ordering patterns of these tests in our local health region and to develop a laboratory algorithm aimed at reducing unnecessary tests. Laboratory data including the number and sequence of tests, ordering physician specialties and results for antinuclear (ANA), extractable nuclear antigen (ENA) and anti-double stranded DNA (anti-dsDNA) antibody tests from 2007 to 2009 were evaluated. Based on this information and a clinical consensus meeting, an algorithm was developed and applied retrospectively to 1 year of inpatient laboratory data to simulate potential cost savings. We identified a large volume of these autoantibody tests performed, equating to testing costs of $862,706.72, where less than 17 % of each were positive. Repeated ANA tests were mostly ordered after a previously negative result, and 1 % of patients with negative results changed to ≥1:160 on repeat testing. Close to half of all ENA and anti-dsDNA tests that were ordered were done so simultaneously with ANA, suggesting their use as screening tests. This was done more frequently in the inpatient setting. An algorithm was developed where ENA and anti-dsDNA tests would be cancelled if ANA was negative in the same sample. ANA repeated within 1 year would be cancelled and the prior result provided. Application of the algorithm retrospectively simulated a 30 % cost savings. Repeat testing and simultaneous ordering of multiple tests contributed to the excessive ordering of autoantibody tests in our health region. Our proposed algorithm would reduce testing costs and should be accompanied by appropriate educational information for physicians. 10.1007/s10067-012-2141-y
Current laboratory and clinical practices in reporting and interpreting anti-nuclear antibody indirect immunofluorescence (ANA IIF) patterns: results of an international survey. Van Hoovels Lieve,Broeders Sylvia,Chan Edward K L,Andrade Luis,de Melo Cruvinel Wilson,Damoiseaux Jan,Viander Markku,Herold Manfred,Coucke Wim,Heijnen Ingmar,Bogdanos Dimitrios,Calvo-Alén Jaime,Eriksson Catharina,Kozmar Ana,Kuhi Liisa,Bonroy Carolien,Lauwerys Bernard,Schouwers Sofie,Lutteri Laurence,Vercammen Martine,Mayer Miroslav,Patel Dina,Egner William,Puolakka Kari,Tesija-Kuna Andrea,Shoenfeld Yehuda,de Sousa Maria José Rego,Hoyos Marcos Lopez,Radice Antonella,Bossuyt Xavier Auto- immunity highlights BACKGROUND:The International Consensus on Antinuclear Antibody (ANA) Patterns (ICAP) has recently proposed nomenclature in order to harmonize ANA indirect immunofluorescence (IIF) pattern reporting. ICAP distinguishes competent-level from expert-level patterns. A survey was organized to evaluate reporting, familiarity, and considered clinical value of ANA IIF patterns. METHODS:Two surveys were distributed by European Autoimmunity Standardization Initiative (EASI) working groups, the International Consensus on ANA Patterns (ICAP) and UK NEQAS to laboratory professionals and clinicians. RESULTS:438 laboratory professionals and 248 clinicians from 67 countries responded. Except for dense fine speckled (DFS), the nuclear competent patterns were reported by > 85% of the laboratories. Except for rods and rings, the cytoplasmic competent patterns were reported by > 72% of laboratories. Cytoplasmic IIF staining was considered ANA positive by 55% of clinicians and 62% of laboratory professionals, with geographical and expertise-related differences. Quantification of fluorescence intensity was considered clinically relevant for nuclear patterns, but less so for cytoplasmic and mitotic patterns. Combining IIF with specific extractable nuclear antigens (ENA)/dsDNA antibody testing was considered most informative. Of the nuclear competent patterns, the centromere and homogeneous pattern obtained the highest scores for clinical relevance and the DFS pattern the lowest. Of the cytoplasmic patterns, the reticular/mitochondria-like pattern obtained the highest scores for clinical relevance and the polar/Golgi-like and rods and rings patterns the lowest. CONCLUSION:This survey confirms that the major nuclear and cytoplasmic ANA IIF patterns are considered clinically important. There is no unanimity on classifying DFS, rods and rings and polar/Golgi-like as a competent pattern and on reporting cytoplasmic patterns as ANA IIF positive. 10.1186/s13317-020-00139-9
Retrospective analysis of the clinical significance of Ro52/TRIM21 antibody and specific antinuclear antibody patterns by indirect immunofluorescence. JPMA. The Journal of the Pakistan Medical Association Objectives:To determine the clinical significance of Ro52 protein/tripartite motif-containing 21 antibody and specific antinuclear antibody patterns using indirect immunofluorescence technique. METHODS:The retrospective study was conducted at the clinical laboratory of the First Affiliated Hospital of Chongqing Medical University, China, and comprised data from January 2017 to December 2021 of patients who underwent antinuclear antibody and anti-extractable nuclear antigen antibody detection. Inpatients with Ro52 antibody-positive status were taken as the cases, while anti-Ro52 negative patients with clear clinical diagnosis were taken as the controls. Data was analysed using SPSS 19. RESULTS:There were 1802 cases and 1211 controls. Positive Ro52 showed significantly greater frequency in patients with primary Sjogren's syndrome, systemic lupus erythematosus, inflammatory myositis, dry eyes and interstitial lung disease (p<0.05). Ro52 antibody showed high positive predictive value for primary Sjogren's syndrome 25(96.15%), systemic lupus erythematosus 259(91.20%), connective tissue disease-associated interstitial lung disease 45(86.67%) and inflammatory myositis 60(86.67%). Antinuclear antibody indirect immunofluorescence patterns most frequently detected were nuclear speckled 128(40.89%) and cytoplasmic speckled 126(40.26%) (p<0.05). Interstitial lung disease was associated with the presence of cytoplasmic speckled antinuclear antibody indirect immunofluorescence pattern 24(19.2%), while tumours 47(36.5%) and hepatitis B 26(20.3%) seemed to be more frequent with nuclear speckled pattern (p<0.05). The simultaneous reactivity extractable nuclear antigen antibodies most frequently detected were antinuclear antibody+Ro52+anti-Sjogren's syndrome A+ 558(33.96%). CONCLUSIONS:Ro52 antibody positivity was found to be associated with Sjogren's syndrome, systemic lupus erythematosus, inflammatory myositis, dry eye and interstitial lung disease. The antinuclear antibody immunofluorescence pattern of Ro52 positive was single and primarily granular cytoplasm type. Antinuclear antibody negative and Ro52 positive in the serum of patients also had certain significance in auxiliary disease diagnosis. 10.47391/JPMA.8027
[Application of Antinuclear Antibody and Antinuclear Antibody Spectrum in Lymphoma Treatment]. Wang Mei-E,Fan Chun-Mei Zhongguo shi yan xue ye xue za zhi OBJECTIVE:To investigate the significance of antinuclear antibody and antinuclear antibody spectrum in the stage and prognosis of lymphoma patients. METHODS:79 cases of lymphoma (lymphoma group) treated in the Second Affiliated Hospital of Fujian Medical University and 50 cases of healthy people (control group) were selected. Antinuclear antibodies (ANA) were detected by indirect innmunofluorescence and ANA spectrums were detected by linear Western blot, the expression level of ANA and ANA spectrum in the two groups were analyzed. The lymphoma group was divided into the positive and the negative group according to ANA level, the levels of lactate dehydrogenase (LDH), white blood cell (WBC), disease type, stage and prognosis of the two groups were compared. RESULTS:In the lymphoma group, the positive rate of ANA was 48.1%, while the positive rate was 8.0% in the health control group, both of them showed statistically significant (χ=22.42, P<0.05). ANA fluorescence karyotype in lymphoma group was mainly speckle type. In the Lymphoma group, the positive rate of ANA spectrum was 29.1%, while the positive rate in the control group was 4.0%, both of them showed statistically significant (χ=12.36, P<0.05). The target antigen distribution of ANA spectrum in the lymphoma group was relatively complex, mainly RO52 and SSA, while that in the control group was simple. The positive rate of ANA in lymphoma patients showed increased with age, the titer was mainly 1∶100 low titer positive, the positive rate of ANA in female patients was higher than that in male patients; The average count±standard deviation of LDH and WBC in the ANA positive and negative group were (253.67±255.85) U/L, (218.18±208.34) U/L, (6.34±3.31)×10/L and (6.81±3.91)×10/L respectively, which showed no statistical significance between the two groups (t=0.59 P>0.05; t=0.57 P>0.05); B-cell lymphoma was the main disease in both groups, which accounted for 81.6% (31/38) and 68.3% (28/41) respectively; while in B-cell lymphoma, diffuse large B-cell lymphoma was the main lymphoma. For the patients with B-cell lymphoma, the patients at stage IV in ANA positive group was 58.1% (18/31), while that in the ANA negative group was 28.6% (8 / 28), and both of them showed statistically significant (χ=5.19, P<0.05). Follow-up showed that the survival rate of the patients in ANA negative group was higher than that in ANA positive group, which showed statistically significant difference (P<0.05). CONCLUSION:The postive rate of antinuclear antibody and antinuclear antibody spectrum are higher in lymphoma patients, which have considerable significance for the stage and prognosis of lymphoma treatment. 10.19746/j.cnki.issn.1009-2137.2020.03.023
Utility of the HEp-2000 antinuclear antibody substrate. Lee Adrian Y S,Beroukas Dimitra,Roberts-Thomson Peter J Annals of the rheumatic diseases 10.1136/annrheumdis-2019-215519
Antinuclear antibody profiling in uveitis. Ten Berge Josianne C,Groen-Hakan Fahriye,Rothova Aniki,Schreurs Marco W J Acta ophthalmologica 10.1111/aos.13709
Value of combined detection of anti-nuclear antibody, anti-double-stranded DNA antibody and C3, C4 complements in the clinical diagnosis of systemic lupus erythematosus. Qu Changhua,Zhang Juan,Zhang Xiumei,Du Jiexin,Su Baifang,Li Hong Experimental and therapeutic medicine Combined detection of antinuclear antibody (ANA), anti-double-stranded DNA (ds-DNA) antibody and complements C3 and C4 in the diagnosis of systemic lupus erythematosus (SLE) was analyzed. One hundred and ninety-four patients with SLE admitted to Yantaishan Hospital of Yantai from January 2012 to December 2017 were selected as SLE group. A total of 106 patients with non-SLE rheumatic disease were selected as disease control group and 120 healthy subjects as healthy control group. The ANA and anti-ds-DNA antibodies were detected by ELISA and complement C3 and C4 were detected by rate nephelometry. The sensitivity and specificity of these four factors were also analyzed for the diagnosis of SLE. The sensitivity and specificity of ANA in diagnosing SLE were 91.75 and 79.65%, respectively; of anti-ds-DNA antibody were 67.01 and 98.23%, respectively; of complement C3 were 87.11 and 82.74%, respectively; and of complement C4 were 88.66 and 77.43%, respectively. The sensitivity and specificity of ANA and anti-ds-DNA antibody in the diagnosis of SLE were 95.36 and 96.90%, respectively; of C3 and C4 were 92.78 and 79.20%, respectively; and the sensitivity and specificity of the combination of all four indicators were 97.42 and 80.97%, respectively. The combined diagnosis of SLE with ANA, anti-ds-DNA antibody, complement C3 and C4 can play a complementary role in the diagnosis and treatment of SLE patients, and it is of great significance to the diagnosis and treatment planning of SLE patients. 10.3892/etm.2018.7072
Evaluation of the Automated Indirect Immunofluorescence Test for Antinuclear Antibodies. Wu Shiji,Liu Feng,Wang Feng,Huang Jin,Yin Botao,Huang Min,Wang Ting,Wei Na Annals of clinical and laboratory science The performance of the automated indirect immunofluorescence system was compared with the manual method for detection of antinuclear antibodies (ANA) from 354 clinical serum samples. We compared the results (negative or positive), ANA patterns, and titers for the two methods. The coincidence rates for ANA positive and negative samples were 93.4% and 98.7%, respectively. The coincidence rates for single patterns, mixed patterns, and the final titers were 85.1%, 87.6%, and 87.6%, respectively. The homogeneous, speckled, cytoplasmic, centromere, multiple nuclear dots, and nucleolar pattern coincidence rates were 79.3%, 83.0%, 87.8%, 72.7%, 50%, and 56.3%, respectively. The automated indirect immunofluorescence system had acceptable accuracy for detection of ANA.
Clinicopathological significance of antinuclear antibodies in non-alcoholic steatohepatitis. Niwa Hideki,Sasaki Motoko,Haratake Joji,Kasai Takahiko,Katayanagi Kazuyoshi,Kurumaya Hiroshi,Masuda Shinji,Minato Hiroshi,Zen You,Uchiyama Akio,Miwa Atsuo,Saito Katsuhiko,Sudo Yoshiko,Nakanuma Yasuni Hepatology research : the official journal of the Japan Society of Hepatology AIM:Serum antinuclear antibodies (ANA) are occasionally noted in patients with non-alcoholic steatohepatitis (NASH). We examined the significance of ANA in NASH. METHODS:We compared clinicopathological features in patients with ANA-positive NASH (n = 35) and ANA-negative NASH (n = 36). Inflammatory cell profiles and the distribution of oxidative stress markers were also examined immunohistochemically. RESULTS:ANA-positive NASH was significantly associated with female gender (P = 0.005), high degree of portal inflammation (P = 0.039), interface activity (P = 0.036) and hepatocellular ballooning (P = 0.0008). In addition, ANA of high titer (320-fold or more) was significantly associated with the histological grade and stage of NASH (P = 0.02). The degree of steatosis wais rather mild in the high-titer ANA group(P = 0.01). The analysis of inflammatory cell profiles revealed that CD3-positive T cells were predominant and plasma cells were rather few in the portal area and hepatic lobules in both ANA-positive and ANA-negative groups. There was no difference in the distribution of oxidative stress markers between ANA-positive and ANA-negative groups. CONCLUSION:These findings suggest that the presence of ANA may be related to the progression of NASH and that a different type of autoimmune mechanism may be involved in the pathogenesis of NASH with ANA, compared to the pathogenesis of autoimmune hepatitis. 10.1111/j.1872-034X.2007.00150.x