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Ostrov BE. Reliability and reproducibility of antinuclear antibody testing in pediatric rheumatology practice. Front Med (Lausanne) 2023; 9:1071115. [PMID: 36714114 PMCID: PMC9875300 DOI: 10.3389/fmed.2022.1071115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023] Open
Abstract
Antinuclear antibody (ANA) testing is common practice among health care practitioners when evaluating children and adolescents with non-specific symptoms including fatigue and aches and pains. When positive, ANA results often lead to referrals to pediatric rheumatologists as these antibodies may be key indicators for specific pediatric rheumatologic diagnoses. The reliability and reproducibility of ANA tests varies with assay techniques and validation and interpretation of results. In the following article, review of ANA testing in pediatrics is provided along with case examples that demonstrate the reliability and reproducibility of these results in specific scenarios common in the practice of pediatric rheumatology. Guidelines for more accurate utilization of ANA testing are presented with the aim to improve testing and interpretation by ordering clinicians.
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Storwick JA, Brett A, Buhler K, Chin A, Schmeling H, Johnson N, Fritzler MJ, Choi MY. Prevalence and titres of antinuclear antibodies in juvenile idiopathic arthritis: A systematic review and meta-analysis. Clin Exp Rheumatol 2022; 21:103086. [DOI: 10.1016/j.autrev.2022.103086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/05/2022] [Indexed: 11/02/2022]
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Leuchten N, Hoyer A, Brinks R, Schoels M, Schneider M, Smolen J, Johnson SR, Daikh D, Dörner T, Aringer M, Bertsias G. Performance of Antinuclear Antibodies for Classifying Systemic Lupus Erythematosus: A Systematic Literature Review and Meta-Regression of Diagnostic Data. Arthritis Care Res (Hoboken) 2018; 70:428-438. [DOI: 10.1002/acr.23292] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 05/16/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Nicolai Leuchten
- University Medical Center Carl Gustav Carus, TU Dresden; Dresden Germany
| | - Annika Hoyer
- German Diabetes Center; Institute for Biometry and Epidemiology; Duesseldorf Germany
| | - Ralph Brinks
- Hiller Center for Research in Rheumatology; Duesseldorf Germany
| | | | | | - Josef Smolen
- Medical University of Vienna and Hietzing Hospital; Vienna Austria
| | - Sindhu R. Johnson
- Toronto Western Hospital; Mount Sinai Hospital; and University of Toronto; Toronto Canada
| | | | | | - Martin Aringer
- University Medical Center Carl Gustav Carus, TU Dresden; Dresden Germany
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Nordal E, Rypdal V, Christoffersen T, Aalto K, Berntson L, Fasth A, Herlin T, Nielsen S, Peltoniemi S, Straume B, Zak M, Rygg M. Incidence and predictors of Uveitis in juvenile idiopathic arthritis in a Nordic long-term cohort study. Pediatr Rheumatol Online J 2017; 15:66. [PMID: 28821293 PMCID: PMC5562983 DOI: 10.1186/s12969-017-0195-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/11/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The incidence of uveitis associated with juvenile idiopathic arthritis (JIA) varies around the world. Our aim was to investigate the incidence and predictors of uveitis in a Nordic population-based cohort. METHODS Consecutive JIA cases from defined geographical areas in Denmark, Finland, Sweden and Norway with disease onset between January 1997 to June 2000 were followed for median 98 months in this prospective longitudinal cohort study. Potential clinical and immunological predictors of uveitis were identified with logistic regression analysis. RESULTS Uveitis occurred in 89 (20.5%) of the 435 children with regular ophtalmologic follow-up among the 500 included. Chronic asymptomatic uveitis developed in 80 and acute symptomatic uveitis in 9 children. Uveitis developed at a median interval of 0.8 (range - 4.7 to 9.4) years after onset of arthritis. Predictors of uveitis were age < 7 years at JIA onset (Odds ratio (OR) 2.1, 95% confidence interval (CI) 1.3 to 3.5), presence of antihistone antibodies (AHA) > 15 U/ml (OR 4.8 (1.8 to 13.4)) and antinuclear antibodies (ANA) (OR 2.4 (1.5 to 4.0)). Mean combined IgM/IgG AHA was significantly higher in the uveitis group (19.2 U/ml) than in the non-uveitis group (10.2 U/ml) (p = 0.002). Young age at JIA onset predicted uveitis in girls (p < 0.001), but not in boys (p = 0.390). CONCLUSION Early-onset arthritis and presence of AHA in girls, as well as presence of ANA in both genders, were significant predictors of chronic uveitis. The high incidence of uveitis in this long-term Nordic JIA cohort may have severe implications in a lifelong perspective.
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Affiliation(s)
- Ellen Nordal
- Department of Pediatrics, University Hospital of North Norway, and Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
| | - Veronika Rypdal
- 0000000122595234grid.10919.30Department of Pediatrics, University Hospital of North Norway, and Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Terje Christoffersen
- 0000000122595234grid.10919.30Department of Ophtalmology, University Hospital of North Norway, and Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kristiina Aalto
- 0000 0004 0410 2071grid.7737.4Pediatric Rheumatology Clinic, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Lillemor Berntson
- 0000 0004 1936 9457grid.8993.bDepartment of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Anders Fasth
- 0000 0000 9919 9582grid.8761.8Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Troels Herlin
- 0000 0004 0512 597Xgrid.154185.cDepartment of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Susan Nielsen
- grid.475435.4Pediatric Rheumatology Clinic, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Suvi Peltoniemi
- 0000 0004 0410 2071grid.7737.4Pediatric Rheumatology Clinic, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Bjørn Straume
- 0000000122595234grid.10919.30Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Marek Zak
- grid.475435.4Pediatric Rheumatology Clinic, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Marite Rygg
- 0000 0001 1516 2393grid.5947.fDepartment of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, and Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
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Hira-Kazal R, Shea-Simonds P, Peacock JL, Maher J. How should a district general hospital immunology service screen for anti-nuclear antibodies? An 'in-the-field' audit. Clin Exp Immunol 2014; 180:52-7. [PMID: 25412573 DOI: 10.1111/cei.12556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2014] [Indexed: 11/29/2022] Open
Abstract
Anti-nuclear antibody (ANA) testing assists in the diagnosis of several immune-mediated disorders. The gold standard method for detection of these antibodies is by indirect immunofluorescence testing on human epidermoid laryngeal carcinoma (HEp-2) cells. However, many laboratories test for these antibodies using solid-phase assays such as enzyme-linked immunosorbent assay (ELISA), which allows for higher throughput testing at reduced cost. In this study, we have audited the performance of a previously established ELISA assay to screen for ANA, making comparison with the gold standard HEp-2 immunofluorescence test. A prospective and unselected sample of 89 consecutive ANA test requests by consultant rheumatologists were evaluated in parallel over a period of 10 months using both tests. ELISA and HEp-2 screening assays yielded 40 (45%) and 72 (81%) positive test results, respectively, demonstrating lack of concordance between test methods. Using standard and clinical samples, it was demonstrated that the ELISA method did not detect several ANA with nucleolar, homogeneous and speckled immunofluorescence patterns. None of these ELISA(NEG) HEp-2(POS) ANA were reactive with a panel of six extractable nuclear antigens or with double-stranded DNA. Nonetheless, 13 of these samples (15%) originated from patients with recognized ANA-associated disease (n = 7) or Raynaud's phenomenon (n = 6). We conclude that ELISA screening may fail to detect clinically relevant ANA that lack defined specificity for antigen.
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Affiliation(s)
- R Hira-Kazal
- Department of Immunology, Royal Free London NHS Foundation Trust, Barnet Hospital, Barnet, UK
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