Artikel
Anti-DFS70 antibodies without disease specific antibodies help to rule out ANA associated rheumatic diseases
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Autoren
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Nadja Röber
- Institut für Immunologie, Medizinische Fakultät der Technischen Universität Dresden, Dresden
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Uwe Höpner
- Institut für Immunologie, Medizinische Fakultät der Technischen Universität Dresden, Dresden
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Martin Aringer
- Universitätsklinikum „Carl Gustav Carus“ an der Technischen Universität Dresden, Medizinische Klinik III, Rheumatologie, Dresden
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Sebastian E. Rudolph
- Zeisigwaldkliniken Bethanien Chemnitz, Klinik für Innere Medizin und Rheumatologie, Chemnitz
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Anett Gräßler
- Schwerpunktpraxis für Rheumatologie, Pirna
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Kirsten Lüthke
- Schwerpunktpraxis Rheumatologie, Dresden
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Leonore Unger
- Städtisches Klinikum Dresden-Friedrichstadt, I. Medizinische Klinik, Dresden
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Michael Mahler
- INOVA Diagnostics Inc., Research and Development, San Diego, USA
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Karsten Conrad
- Institut für Immunologie, Medizinische Fakultät der Technischen Universität Dresden, Dresden
| Veröffentlicht: | 29. August 2016 |
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Gliederung
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Background: Antinuclear antibodies (ANA) determined by indirect immunofluorescence are the primary screening test for patients suspected to suffer from ANA associated rheumatic diseases (AARD). While ANA have high sensitivity, their specificity is low, because they are detectable also in other patients and in apparently healthy individuals (AHI). Therefore, positive ANA may lead to additional testing and potentially even inappropriate treatment in patients with musculoskeletal symptoms not caused by AARD. It has been shown that autoantibodies directed against DFS70, are common among ANA positive individuals with no evidence of AARD.
Methods: To address this issue, we studied 352 AHI, and cohorts of patients using a novel chemoluminescence assay (CIA) for the determination of anti-DFS70 antibodies (QUANTA FLASH DFS70, Inova Diagnostica, Inc., San Diego, USA): (a) routine cohort of 1048 patients with homogenous ANA in the absence of chromatin binding autoantibodies, (b) 580 patients with AARD (300 SLE, 77 idiopathic inflammatory myopathies, 167 systemic sclerosis, 36 Sjögren’s syndrome), (c) 56 patients with possible AARD, and (d) 625 non-AARD patients (302 rheumatoid arthritis, 94 ANCA-associated vasculitis, 87 atopic rhinitis, 100 pediatric patients with celiac disease, and 42 autoimmune liver diseases).
Results: Of the 1048 selected routine sera, 205 sera (19.6%) were positive for anti-DFS70 by CIA. All anti-DFS70 positive sera showed the typical dense fine speckled pattern on HEp-2 cells. Up to now, clinical reports are available for 116 of anti-DFS70 positive patients in this group. Various diseases but no definite AARD were diagnosed according to available data.
In AHI and in the non-AARD cohort, anti-DFS70 antibodies occur with a prevalence of 5.1% and 1.9%, respectively.
In the AARD group only 7 of 580 patients (1.2%) were positive for anti-DFS70 antibodies. 6 of them also show disease specific autoantibodies. In patients with possible AARD, 6 were anti-DFS70 antibody positive in the absence of disease specific autoantibodies. Up to now, no development of a definite SLE or other AARD was observed in these patients.
Conclusion: The determination of anti-DFS70 antibodies may be helpful in differentiating ANA positive patients with rheumatic symptoms not caused by AARD from patients with definite AARD.
