Anti-Nuclear Antibodies in Daily Clinical Practice: Prevalence in Primary, Secondary, and Tertiary Care
For the diagnosis of systemic autoimmune rheumatic diseases (SARD), patients are screened for anti-nuclear antibodies (ANA). ANA, as assessed by indirect immunofluorescence (IIF), have a poor specificity. This hampers interpretation of positive results in clinical settings with low pretest probabili...
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| Language: | English |
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Wiley
2014-01-01
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| Series: | Journal of Immunology Research |
| Online Access: | http://dx.doi.org/10.1155/2014/401739 |
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| author | Thomas Y. Avery Mart van de Cruys Jos Austen Frans Stals Jan G. M. C. Damoiseaux |
| author_facet | Thomas Y. Avery Mart van de Cruys Jos Austen Frans Stals Jan G. M. C. Damoiseaux |
| author_sort | Thomas Y. Avery |
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| description | For the diagnosis of systemic autoimmune rheumatic diseases (SARD), patients are screened for anti-nuclear antibodies (ANA). ANA, as assessed by indirect immunofluorescence (IIF), have a poor specificity. This hampers interpretation of positive results in clinical settings with low pretest probability of SARD. We hypothesized that the utility of positive ANA IIF results increases from primary to tertiary care. We retrospectively determined ANA, anti-ENA, and anti-dsDNA antibody prevalence in patient cohorts from primary (n=1453), secondary (n=1621), and tertiary (n=1168) care settings. Results reveal that from primary care to tertiary care, ANA prevalence increases (6.2, 10.8, and 16.0%, resp.). Moreover, in primary care low titres (70% versus 51% and 52% in secondary and tertiary care, resp.) are more frequent and anti-ENA/dsDNA reactivities are less prevalent (21% versus 39% in secondary care). Typically, in tertiary care the prevalence of anti-ENA/dsDNA reactivities (21%) is lower than expected. From this descriptive study we conclude that positive ANA IIF results are more prone to false interpretation in clinical settings with low pretest probabilities for SARD, as in primary care. Whether alternative approaches, that is, immunoadsorption of anti-DFS70 antibodies or implementation of anti-ENA screen assays, perform better, needs to be determined. |
| format | Article |
| id | doaj-art-3b4c78e20c1e4c31881f7b7953090a2c |
| institution | Kabale University |
| issn | 2314-8861 2314-7156 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
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| series | Journal of Immunology Research |
| spelling | doaj-art-3b4c78e20c1e4c31881f7b7953090a2c2025-02-03T01:07:04ZengWileyJournal of Immunology Research2314-88612314-71562014-01-01201410.1155/2014/401739401739Anti-Nuclear Antibodies in Daily Clinical Practice: Prevalence in Primary, Secondary, and Tertiary CareThomas Y. Avery0Mart van de Cruys1Jos Austen2Frans Stals3Jan G. M. C. Damoiseaux4Central Diagnostic Laboratory, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The NetherlandsDepartment of Microbiology, Atrium Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The NetherlandsCentral Diagnostic Laboratory, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The NetherlandsDepartment of Microbiology, Atrium Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The NetherlandsCentral Diagnostic Laboratory, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The NetherlandsFor the diagnosis of systemic autoimmune rheumatic diseases (SARD), patients are screened for anti-nuclear antibodies (ANA). ANA, as assessed by indirect immunofluorescence (IIF), have a poor specificity. This hampers interpretation of positive results in clinical settings with low pretest probability of SARD. We hypothesized that the utility of positive ANA IIF results increases from primary to tertiary care. We retrospectively determined ANA, anti-ENA, and anti-dsDNA antibody prevalence in patient cohorts from primary (n=1453), secondary (n=1621), and tertiary (n=1168) care settings. Results reveal that from primary care to tertiary care, ANA prevalence increases (6.2, 10.8, and 16.0%, resp.). Moreover, in primary care low titres (70% versus 51% and 52% in secondary and tertiary care, resp.) are more frequent and anti-ENA/dsDNA reactivities are less prevalent (21% versus 39% in secondary care). Typically, in tertiary care the prevalence of anti-ENA/dsDNA reactivities (21%) is lower than expected. From this descriptive study we conclude that positive ANA IIF results are more prone to false interpretation in clinical settings with low pretest probabilities for SARD, as in primary care. Whether alternative approaches, that is, immunoadsorption of anti-DFS70 antibodies or implementation of anti-ENA screen assays, perform better, needs to be determined.http://dx.doi.org/10.1155/2014/401739 |
| spellingShingle | Thomas Y. Avery Mart van de Cruys Jos Austen Frans Stals Jan G. M. C. Damoiseaux Anti-Nuclear Antibodies in Daily Clinical Practice: Prevalence in Primary, Secondary, and Tertiary Care Journal of Immunology Research |
| title | Anti-Nuclear Antibodies in Daily Clinical Practice: Prevalence in Primary, Secondary, and Tertiary Care |
| title_full | Anti-Nuclear Antibodies in Daily Clinical Practice: Prevalence in Primary, Secondary, and Tertiary Care |
| title_fullStr | Anti-Nuclear Antibodies in Daily Clinical Practice: Prevalence in Primary, Secondary, and Tertiary Care |
| title_full_unstemmed | Anti-Nuclear Antibodies in Daily Clinical Practice: Prevalence in Primary, Secondary, and Tertiary Care |
| title_short | Anti-Nuclear Antibodies in Daily Clinical Practice: Prevalence in Primary, Secondary, and Tertiary Care |
| title_sort | anti nuclear antibodies in daily clinical practice prevalence in primary secondary and tertiary care |
| url | http://dx.doi.org/10.1155/2014/401739 |
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