anti-nuclear antibodies significance and limitations of test by hatem h. eleishi consultant...
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Anti-nuclear antibodiesSignificance and limitations of test
By Hatem H. EleishiConsultant Rheumatologist
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In this mini-lecture:
What are ANAs
How useful they are
How unuseful they can be
Conclusion
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What are antinuclear antibodies?
Antibodies to nuclear proteins
What are nuclear proteins?
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Proteins that have been synthesized in the nucleus and thereafter where distributed to their respective sites in the cell Nucleosomes
Ro
La
Smith
RNP
Jo-1
Scl-70
Ro
dsDNA
Nucleolar proteins
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Ro
La
Smith
RNP
Jo-1
Scl-70
Ro
Nucleolar
dsDNA
Rim
Speckled
Homogenous Nucleosomes
Ro
La
Smith
RNP
Jo-1
Scl-70
Ro
dsDNA
Nucleolar proteins
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Importance of ANAs
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One: Serologic hallmarks of patients with systemic autoimmune disease (ANA diseases).
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Serologic hallmarks of patients with systemic autoimmune disease: • SLE – sensitivity, 99 percent • Scleroderma – 97 percent • Mixed connective tissue disease – 93 percent • Polymyositis/dermatomyositis – 61 percent • Rheumatoid arthritis – 52 percent • Rheumatoid vasculitis – 33 percent • Sjögren's syndrome – 90 percent • Drug-induced lupus –100 percent • Discoid lupus – 15 percent • Pauciarticular juvenile chronic arthritis – 71 percent
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TwoCan provide further diagnostic and prognostic data concerning patients who have minimal symptoms or who have clinical features of more than one autoimmune disease.
Examples
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A young female with: PolyarthralgiasFatigueMalar rashPositive ANA
A lupus patient with: Anti-Ro antibodies
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Limitations of utility and reliability
of ANA in diagnosis
of systemic autoimmune diseases
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One:Can also be found in association with: Many autoimmune disorders that are not
defined by these antibodies
In certain infections and other disorders
In patients receiving certain drugs too.
Autoimmune disorders that are not defined by these antibodies: Hashimoto's thyroiditis – 46 percentGraves' disease – 50 percentAutoimmune hepatitis – 71 percentPrimary autoimmune cholangitis – 100 percentPrimary pulmonary hypertension – 40 percent
Chronic infectious diseases:MononucleosisSubacute bacterial endocarditisTuberculosisOther disorders: Some lymphoproliferative diseases.
In up to 50 percent of patients taking certain drugs; however, most of these patients do not develop drug-induced lupus.
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Two: Their presence does not mandate the
presence of illness, since they can also be found in otherwise normal individuals.
False positive ANAs (ie, ANAs in the absence of autoimmune disease or known antigenic stimuli) are more commonly seen in women and in elderly patients. They are invariably in low titer.
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Three: Accurate interpretation of different nuclear patterns is confounded several difficulties as: • The recognition of specific patterns is operator-dependent, and does not produce a permanent record. The fluorescence fades in one to two days, so that one cannot compare a result with other samples without photographing each test result.• One nuclear pattern may obscure and prevent the recognition of another pattern if several antibodies are present simultaneously.
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As a result,
A positive ANA, although useful and important, yet should be interpreted with caution and within the appropriate clinical setting
As a result,
A good history compounded with a thorough clinical examination remain to be the mainstay of diagnosis
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Thank you