Systemic Lupus Erythematosus
Pattern on the antinuclear antibody–HEp-2 test is a critical parameter for discriminating antinuclear antibody–positive healthy individuals and patients with autoimmune rheumatic diseases
Version of Record online: 28 DEC 2010
Copyright © 2011 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 63, Issue 1, pages 191–200, January 2011
How to Cite
Mariz, H. A., Sato, E. I., Barbosa, S. H., Rodrigues, S. H., Dellavance, A. and Andrade, L. E. C. (2011), Pattern on the antinuclear antibody–HEp-2 test is a critical parameter for discriminating antinuclear antibody–positive healthy individuals and patients with autoimmune rheumatic diseases. Arthritis & Rheumatism, 63: 191–200. doi: 10.1002/art.30084
- Issue online: 28 DEC 2010
- Version of Record online: 28 DEC 2010
- Accepted manuscript online: 15 OCT 2010 11:56AM EST
- Manuscript Accepted: 30 SEP 2010
- Manuscript Received: 7 DEC 2009
- São Paulo Research Foundation (FAPESP). Grant Numbers: 2004/00102-9, 04/00781-3
- Brazilian Society of Rheumatology
To identify features of antinuclear antibody (ANA)–HEp-2 test results that discriminate ANA-positive healthy individuals and patients with autoimmune rheumatic diseases (ARDs).
We sequentially retrieved data on 918 healthy individuals and 153 patients with ARDs after clinical assessment. ANA-positive healthy individuals for whom data were available were reevaluated after 3.6–5.0 years. An ANA–HEp-2 test result was considered positive when a clear ANA pattern was observed at 1:80 dilution in 2 distinct commercial HEp-2 slides by 2 blinded independent observers.
ANAs were present in 118 healthy individuals (12.9%) and 138 patients with ARDs (90.2%). The ANA titer was higher in patients with ARDs than in healthy individuals (P < 0.001). The ANA pattern profile was distinct in the 2 groups. Nuclear homogeneous, nuclear coarse speckled, and nuclear centromeric patterns appeared exclusively in patients with ARDs. The nuclear dense fine speckled pattern occurred only in healthy individuals. The most frequent ANA pattern in both groups was the nuclear fine speckled pattern, which occurred at lower titer in healthy individuals than in patients with ARDs (P < 0.001). Anti–extractable nuclear antigen was present in 1 healthy individual (anti-SSA/Ro) and in 52 patients with ARDs (37.7%). None of the 40 reevaluated healthy individuals developed ARDs, and 29 (72.5%) remained ANA positive. All healthy individuals who became ANA negative had an ANA titer of 1:80 at baseline.
Our findings suggest that the titer, and especially the pattern, on the ANA–HEp-2 test strongly enhances our ability to discriminate ANA-positive healthy individuals and patients with ARDs.