1
|
Shao H, Wu Y, Tao X, Liu Q, Ran C, Jin L, Tao J. The titers of antinuclear antibodies are associated with the degree of inflammation and organ damage in Primary Sjögren's Syndrome. Clin Exp Med 2024; 24:96. [PMID: 38717644 PMCID: PMC11078821 DOI: 10.1007/s10238-024-01357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/17/2024] [Indexed: 05/12/2024]
Abstract
Primary Sjögren's Syndrome (pSS) falls within the category of connective tissue diseases, characterized by the presence of autoantibodies such as antinuclear antibodies (ANA). However, according to the classification criteria for pSS, some patients may exhibit a negative result for autoantibodies. Patients with a negative result for autoantibodies may lack typical features of connective tissue diseases, and the immunological state as well as the extent of organ involvement and damage may differ from those with positive autoantibodies. This study aims to compare the clinical phenotypes of patients with positive and negative autoantibodies, providing insights for disease classification and treatment selection for clinicians. Patients with pSS were grouped based on the presence and titers of their autoantibodies. Subsequently, differences in organ damage and laboratory indicators were compared between these groups, aiming to analyze the value of autoantibody titers in assessing the condition of pSS. (1) Patients with positive ANA exhibited elevated levels of inflammatory indicators, including ESR, IgG levels, lip gland biopsy pathology grade, and overall organ involvement, in comparison with patients with negative ANA (P < 0.05). Furthermore, ANA-positivity correlated with a higher occurrence of multi-organ damage, particularly affecting the skin, mucous membranes, and the hematological system (P < 0.05). (2) As ANA titers increased, patients demonstrated elevated levels of IgG and an escalation in organ involvement (P < 0.05). (3) Patients in the positive autoantibody group (positive for antinuclear antibodies, anti-SSA, or anti-SSB antibodies) had higher IgG levels compared to the negative group (P < 0.05). (4) Patients with positive anti-SSA and anti-SSB antibodies exhibited higher levels of inflammatory indicators and IgG compared to other patients (P < 0.05); however, no significant differences were observed in terms of organ involvement and organ damage. Patients with positive ANA in pSS typically exhibit higher levels of inflammation and an increased likelihood of experiencing multi-organ damage. Furthermore, as the ANA titers increase, both inflammation levels and the risk of multi-organ damage also escalate. Additionally, the presence of anti-SSA and anti-SSB antibodies may contribute to an elevated risk of increased inflammation levels, but does not increase the risk of organ damage.
Collapse
Affiliation(s)
- Huijun Shao
- Department of Rheumatology and Immunology, Anhui Provincial Hospital Affiliated to Anhui Medical University, No. 17 Lijiang Road, Hefei, 230001, Anhui, China
- Department of Allergy and Clinical Immunity, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lijiang Road, Hefei, 230001, Anhui, China
| | - Yue Wu
- Department of Rheumatology and Immunology, Anhui Provincial Hospital Affiliated to Anhui Medical University, No. 17 Lijiang Road, Hefei, 230001, Anhui, China
- Department of Allergy and Clinical Immunity, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lijiang Road, Hefei, 230001, Anhui, China
| | - Xinyu Tao
- Department of Clinical Medicine "5 + 3" Integration, The First Clinical College, Anhui Medical University, No. 17 Lijiang Road, Hefei, 230001, Anhui, China
| | - Qun Liu
- Wannan Medical College, No. 10 Kangfu Road, Wuhu, 241000, Anhui, China
| | - Chenyu Ran
- Wannan Medical College, No. 10 Kangfu Road, Wuhu, 241000, Anhui, China
| | - Li Jin
- Department of Rheumatology and Immunology, Anhui Provincial Hospital Affiliated to Anhui Medical University, No. 17 Lijiang Road, Hefei, 230001, Anhui, China
| | - Jinhui Tao
- Department of Rheumatology and Immunology, Anhui Provincial Hospital Affiliated to Anhui Medical University, No. 17 Lijiang Road, Hefei, 230001, Anhui, China.
- Department of Allergy and Clinical Immunity, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lijiang Road, Hefei, 230001, Anhui, China.
| |
Collapse
|
2
|
Shurin MR, Wheeler SE. Clinical Significance of Uncommon, Non-Clinical, and Novel Autoantibodies. Immunotargets Ther 2024; 13:215-234. [PMID: 38686351 PMCID: PMC11057673 DOI: 10.2147/itt.s450184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
Autoantibodies are a common mark of autoimmune reaction and their identification in the patients' serum, cerebrospinal fluid, or tissues is generally believed to represent diagnostic or prognostic biomarkers of autoimmune diseases or autoinflammatory conditions. Traditionally, autoantibody testing is an important part of the clinical examination of suspected patients, and in the absence of reliable T cell tests, characterization of autoantibody responses might be suitable in finding causes of specific autoimmune responses, their strength, and sometimes commencement of autoimmune disease. Autoantibodies are also useful for prognostic stratification in clinically diverse groups of patients if checked repeatedly. Antibody discoveries are continuing, with important consequences for verifying autoimmune mechanisms, diagnostic feasibility, and clinical management. Adding newly identified autoantibody-autoantigen pairs to common clinical laboratory panels should help upgrade and harmonize the identification of systemic autoimmune rheumatic disorders and other autoimmune conditions. Herein, we aim to summarize our current knowledge of uncommon and novel autoantibodies in the context of discussing their validation, diagnostic practicability, and clinical relevance. The regular updates within the field are important and well justified.
Collapse
Affiliation(s)
- Michael R Shurin
- Division of Clinical Immunopathology, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sarah E Wheeler
- Division of Clinical Immunopathology, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
3
|
Musa M, Chukwuyem E, Ojo OM, Topah EK, Spadea L, Salati C, Gagliano C, Zeppieri M. Unveiling Ocular Manifestations in Systemic Lupus Erythematosus. J Clin Med 2024; 13:1047. [PMID: 38398361 PMCID: PMC10889738 DOI: 10.3390/jcm13041047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/29/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Systemic Lupus Erythematosus (SLE) is a complex autoimmune disorder characterized by immune dysregulation and multi-organ involvement. In this concise brief review, we highlight key insights into Ocular Systemic Lupus Erythematosus (SLE), an intricate autoimmune disorder with diverse organ involvement. Emphasizing the formation of autoantibodies and immune complex deposition, we delve into the inflammation and damage affecting ocular structures. Clinical presentations, ranging from mild dry eye syndrome to severe conditions like retinal vasculitis, necessitate a comprehensive diagnostic approach, including clinical exams, serological testing, and imaging studies. Differential diagnosis involves distinguishing SLE-related ocular manifestations from other autoimmune and non-inflammatory ocular conditions. The multidisciplinary management approach, involving rheumatologists, ophthalmologists, and immunologists, tailors treatment based on ocular involvement severity, encompassing corticosteroids, immunosuppressive agents, and biologics. Follow-up is crucial for monitoring disease progression and treatment response. Future perspectives revolve around advancing molecular understanding, refining diagnostic tools, and exploring targeted therapies. Novel research areas include genetic factors, microbiome composition, and biotechnology for tailored and effective SLE ocular treatments.
Collapse
Affiliation(s)
- Mutali Musa
- Department of Optometry, University of Benin, Benin City 300238, Nigeria;
- Centre for Sight Africa, Onitsha 434112, Nigeria
| | | | - Oluwasola Michael Ojo
- School of Optometry and Vision Sciences, College of Health Sciences, University of Ilorin, Ilorin 240003, Nigeria
| | - Efioshiomoshi Kings Topah
- Department of Optometry, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano 700006, Nigeria
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, 00142 Rome, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Caterina Gagliano
- Faculty of Medicine and Surgery, University of Enna “Kore”, Piazza Dell’Università, 94100 Enna, Italy
- Eye Clinic, Catania University San Marco Hospital, Viale Carlo Azeglio Ciampi, 95121 Catania, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| |
Collapse
|
4
|
Kraev K, Hristov B, Uchikov P, Kraeva M, Basheva-Kraeva Y, Valova S, Koleva-Ivanova M, Popova-Belova S, Sandeva M, Chakarov D, Geneva-Popova M. Comprehensive Exploration of Antinuclear Antibodies (ANAs): Unveiling Clinical Significance, Associations with Cancer, and the Nuances of Differential Diagnosis in Positive ANA Patients. Diagnostics (Basel) 2024; 14:320. [PMID: 38337836 PMCID: PMC10855796 DOI: 10.3390/diagnostics14030320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
This comprehensive review delves into the complex realm of antinuclear antibodies (ANAs), expanding beyond their traditional involvement in autoimmune rheumatic disorders. By digging into historical changes, diagnostic complexity, and clinical significance, the debate reveals the shifting relationships between ANAs, particularly with cancer. Specialized studies provide practical insights on ANA testing processes, standardization, and upcoming challenges. Examining prevalence trends in the United States provides a time dimension to ANA dynamics, linking autoimmune and oncological considerations. The debate delves into the complexity of lupus erythematosus, emphasizing ANAs' diverse presentations and their potential as flexible diagnostic and prognostic indicators. The complex relationship between ANAs and cancer is highlighted, demonstrating their potential as early markers or indicators of malignancies. Looking ahead, this synthesis anticipates advances in personalized medicine and collaborative research, putting ANAs at the forefront of advanced diagnostics and treatments for autoimmune disorders and cancer. This synthesis envisions a future for ANA research in which these antibodies play a critical role in promoting personalized treatment, enhancing diagnostics, and fostering collaborative initiatives that cross traditional boundaries. As ANAs grow more prominent at the junction of autoimmune illnesses and cancer, this synthesis lays the path for further research and novel advances in understanding, diagnosing, and treating complicated medical conditions.
Collapse
Affiliation(s)
- Krasimir Kraev
- Department of Propaedeutics of Internal Diseases “Prof. Dr. Anton Mitov”, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria; (S.P.-B.); (M.G.-P.)
| | - Bozhidar Hristov
- Second Department of Internal Diseases, Section “Gastroenterology”, Medical Faculty, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Petar Uchikov
- Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Maria Kraeva
- Department of Otorhinolaryngology, Medical Faculty, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Yordanka Basheva-Kraeva
- Department of Ophthalmology, Medical Faculty, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| | - Siyana Valova
- Second Department of Internal Diseases, Section “Nephrology”, Medical Faculty, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Maria Koleva-Ivanova
- Department of General and Clinical Pathology, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
| | - Stanislava Popova-Belova
- Department of Propaedeutics of Internal Diseases “Prof. Dr. Anton Mitov”, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria; (S.P.-B.); (M.G.-P.)
| | - Milena Sandeva
- Department of Midwifery, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
| | - Dzhevdet Chakarov
- Department of Propaedeutics of Surgical Diseases, Section of General Surgery, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| | - Mariela Geneva-Popova
- Department of Propaedeutics of Internal Diseases “Prof. Dr. Anton Mitov”, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria; (S.P.-B.); (M.G.-P.)
| |
Collapse
|
5
|
Khan QA, khan T, Abdi P, Farkouh C, Anthony M, Hadi FA, Iram S. Diagnostic Dilemma of ANA-negative Pediatric Systemic Lupus Erythematosus in a South Asian Female. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231174321. [PMID: 37205006 PMCID: PMC10186573 DOI: 10.1177/11795476231174321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/20/2023] [Indexed: 05/21/2023]
Abstract
Background Systemic lupus erythematosus (SLE) is an autoimmune disorder affecting multiple organs with different degrees of severity. SLE is typically diagnosed based on the presence of antinuclear antibodies (ANA) in the serum. However, seronegative SLE is rare and is diagnosed by clinicians when the patient's ANA is negative but fulfills other diagnostic criteria. Case report We report a case of a 15-year-old South Asian female with SLE who had negative antinuclear antibodies yet displayed the typical clinical presentations of photosensitive maculopapular rash, joint pain, alopecia, anemia, and thrombocytopenia. Clinical evaluations in conjunction with lab results were used to establish a diagnosis of ANA-negative SLE. Conclusion ANA positivity is an entry criterion for SLE; rarely, cases of ANA-negative SLE may present. A typical clinical presentation may help determine the diagnosis in such a scenario. However, still, the physician should rule out immunodeficiency and other systemic illnesses before reaching a diagnosis of ANA-negative pediatric SLE.
Collapse
Affiliation(s)
- Qaisar Ali Khan
- Khyber Teaching Hospital MTI KTH,
Peshawar, Pakistan
- Qaisar Ali Khan, Khyber Teaching Hospital
MTI KTH, Peshawar 25120, Pakistan.
| | - Tehmina khan
- Khyber Teaching Hospital MTI KTH,
Peshawar, Pakistan
| | - Parsa Abdi
- Memorial University, St. Johns,
Newfoundland, Canada
| | | | | | | | | |
Collapse
|
6
|
Anis S, Fatima A, Abdul Jabbar S, Arain T. ANA-specific antibodies, ANA patterns, anti-ds-DNA results, and clinical diagnosis: a laboratory and clinical audit. Immunol Res 2022; 71:267-275. [PMID: 36456720 DOI: 10.1007/s12026-022-09347-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
Abstract
The diagnosis of systemic autoimmune diseases (SAID) is challenging, due to overlapping features with other non-immune disorders. Anti-nuclear antibodies (ANA)/anti-cellular antibodies are the sensitive screening tests but anti-double-stranded-deoxyribonucleic acid-antibody (anti-ds-DNA) and ANA-specific antibodies are specific for SAID. We aimed to look at ANA-specific antibodies in our patients and correlated them with ANA patterns, anti-ds-DNA, and clinical diagnosis for proper interpretation and better patient management cost-effectively. A retrospective data analysis of 641 patients was done (1st of February 2019 to 31st of July 2021) who were tested for ANA-specific antibodies at the Immunology Department of Indus Hospital and Health Network. ANA and anti-ds-DNA results and clinical diagnosis were also analyzed for ANA-specific antibody-positive patients. Descriptive data were presented in mean ± standard deviation and frequency percentages whereas inferential data were analyzed with a chi-square test for association between ANA-specific antibodies status, ANA, anti-ds-DNA, and clinical features. ANA-specific antibodies test revealed positivity for at least one autoantibody in 245 (38.2%) patients. Of these, ANA was tested in 206 patients reactive for ANA-specific antibodies and found positive in 195 (95%) as compared to negative (< 0.001). Speckled and homogenous were predominant ANA patterns in ANA-specific antibody-positives (56% and 42% respectively). Multiple ANA patterns were found in 18 patients most commonly with systemic lupus erythematosus (SLE) and mixed connective tissue disorder (MCTD). Anti-SSA were the most common ANA-specific antibodies (50%) and were mostly found in sera with speckled (61/97) and homogenous (38/97) patterns and associated mostly with SLE (48%) and Sjogren's syndrome (86%). Among ANA-negative patients, anti-SSA were the most common antibodies (n = 5). Anti-ds-DNA was found in 66% of SLE patients along with another ANA-specific antibody. This study showed that testing for ANA-specific antibodies cannot be gated on ANA patterns. Also, there is a redundancy of these antibodies with various clinical diagnoses. Moreover, they are useful in making a diagnosis in ANA-negative patients as well with clinical suspicion.
Collapse
Affiliation(s)
- Sabiha Anis
- Department of Pathology and Department of Medicine and Allied, The Indus Hospital and Health Network (IHHN), Karachi, Pakistan.
| | - Areej Fatima
- Department of Pathology, The Indus Hospital and Health Network (IHHN), Karachi, Pakistan
| | - Sidra Abdul Jabbar
- Department of Pathology, The Indus Hospital and Health Network (IHHN), Karachi, Pakistan
| | - Tayyab Arain
- Department of Pathology, The Indus Hospital and Health Network (IHHN), Karachi, Pakistan
| |
Collapse
|
7
|
Antinuclear antibodies in healthy population: Positive association with abnormal tissue metabolism, inflammation and immune dysfunction. Int Immunopharmacol 2022; 113:109292. [DOI: 10.1016/j.intimp.2022.109292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/18/2022] [Accepted: 09/25/2022] [Indexed: 11/05/2022]
|
8
|
Timofeeva AM, Sedykh SE, Ermakov EA, Matveev AL, Odegova EI, Sedykh TA, Shcherbakov DN, Merkuleva IA, Volosnikova EA, Nesmeyanova VS, Tikunova NV, Nevinsky GA. Natural IgG against S-Protein and RBD of SARS-CoV-2 Do Not Bind and Hydrolyze DNA and Are Not Autoimmune. Int J Mol Sci 2022; 23:ijms232213681. [PMID: 36430159 PMCID: PMC9693483 DOI: 10.3390/ijms232213681] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022] Open
Abstract
Since the onset of the COVID-19 pandemic, numerous publications have appeared describing autoimmune pathologies developing after a coronavirus infection, with several papers reporting autoantibody production during the acute period of the disease. Several viral diseases are known to trigger autoimmune processes, and the appearance of catalytic antibodies with DNase activity is one of the earliest markers of several autoimmune pathologies. Therefore, we analyzed whether IgG antibodies from blood plasma of SARS-CoV-2 patients after recovery could bind and hydrolyze DNA. We analyzed how vaccination of patients with adenovirus Sputnik V vaccine influences the production of abzymes with DNase activity. Four groups were selected for the analysis, each containing 25 patients according to their relative titers of antibodies to S-protein: with high and median titers, vaccinated with Sputnik V with high titers, and a control group of donors with negative titers. The relative titers of antibodies against DNA and the relative DNase activity of IgGs depended very much on the individual patient and the donor, and no significant correlation was found between the relative values of antibodies titers and their DNase activity. Our results indicate that COVID-19 disease and vaccination with adenoviral Sputnik V vaccine do not result in the development or enhancement of strong autoimmune reactions as in the typical autoimmune diseases associated with the production of anti-DNA and DNA hydrolyzing antibodies.
Collapse
Affiliation(s)
- Anna M. Timofeeva
- SB RAS Institute of Chemical Biology and Fundamental Medicine, 630090 Novosibirsk, Russia
- Correspondence:
| | - Sergey E. Sedykh
- SB RAS Institute of Chemical Biology and Fundamental Medicine, 630090 Novosibirsk, Russia
- Faculty of Natural Sciences, Novosibirsk State University, 630090 Novosibirsk, Russia
| | - Evgeny A. Ermakov
- SB RAS Institute of Chemical Biology and Fundamental Medicine, 630090 Novosibirsk, Russia
- Faculty of Natural Sciences, Novosibirsk State University, 630090 Novosibirsk, Russia
| | - Andrey L. Matveev
- SB RAS Institute of Chemical Biology and Fundamental Medicine, 630090 Novosibirsk, Russia
| | - Eva I. Odegova
- SB RAS Institute of Chemical Biology and Fundamental Medicine, 630090 Novosibirsk, Russia
| | - Tatiana A. Sedykh
- SB RAS Institute of Chemical Biology and Fundamental Medicine, 630090 Novosibirsk, Russia
| | - Dmitry N. Shcherbakov
- State Research Center of Virology and Biotechnology Vector, 630559 Koltsovo, Russia
- Department of Physical-Chemistry Biology and Biotechnology, Altay State University, 656049 Barnaul, Russia
| | - Iuliia A. Merkuleva
- State Research Center of Virology and Biotechnology Vector, 630559 Koltsovo, Russia
| | | | | | - Nina V. Tikunova
- SB RAS Institute of Chemical Biology and Fundamental Medicine, 630090 Novosibirsk, Russia
- Faculty of Natural Sciences, Novosibirsk State University, 630090 Novosibirsk, Russia
| | - Georgy A. Nevinsky
- SB RAS Institute of Chemical Biology and Fundamental Medicine, 630090 Novosibirsk, Russia
- Faculty of Natural Sciences, Novosibirsk State University, 630090 Novosibirsk, Russia
| |
Collapse
|
9
|
Alrashdi MN, Alrasheedi SM, Alkhdairi A, Alburaq FN, Muteb AE, Alshamikh AS, Almutairi K, Ammar AN, Saleh AL, Nawaf AW. Primary Healthcare Practitioners' Knowledge, Attitude, and Practice Toward Systemic Lupus Erythematosus in the Qassim Region, Saudi Arabia. Cureus 2022; 14:e30297. [PMID: 36407197 PMCID: PMC9658483 DOI: 10.7759/cureus.30297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 06/16/2023] Open
Abstract
Objective The study aims to evaluate the primary healthcare practitioner's (PHCP) knowledge, attitude, and practice toward systemic lupus erythematosus (SLE) and to explore the difficulties of early referral to specialized clinics. Method This is a cross-sectional study conducted between February and March 2022 targeting the PHCP among the primary healthcare centers in Qassim, Saudi Arabia. The study was conducted among 203 participants who enrolled via a cluster random sampling technique depending on the survey. Qualitative categorical variables are expressed as frequencies and percentages, while continuous variables are reported as means and standard deviations (SD). The one-way analysis of variance (ANOVA) test and the independent T-test have been used to explore the relationship between participants' knowledge scores and their socio-demographic characteristics. A P-value ≤0.05 was considered statistically significant. Result The study found that only 4.4% of participating PHCPs had good knowledge related to SLE, while 45.8% of them had fair knowledge, and nearly half of them (49.8%) had poor knowledge. It was noted that GPs who specialized in family medicine or saw more than 40 patients each week had comparably better knowledge than others, which was statistically significant (p<0.05). The difficulty in diagnosing SLE patients was mentioned by 48.3% of the PHCPs. Family medicine consultants (p<0.001), those who worked in a tertiary care facility for more than six months (p<0.001) and those who worked in a rheumatology department (p<0.05), reported considerably better levels of comfort when treating SLE patients. Conclusion This study found that included participants' understanding of SLE, its diagnosis, and management was inadequate. Coordination between rheumatologists and experts from many disciplines at the primary, secondary, and tertiary levels of care is critical for overcoming ambiguities and obstacles in the diagnosis and therapy of SLE patients.
Collapse
Affiliation(s)
- Mousa N Alrashdi
- Department of Medicine, Unaizah Collage of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Sami M Alrasheedi
- Department of Medicine, Unaizah Collage of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Ahmad Alkhdairi
- Department of Medicine, Unaizah Collage of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | | | | | | | - Khalid Almutairi
- Department of Medicine, Unaizah Collage of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | | | | | | |
Collapse
|
10
|
Zhang M, Zhang X. An indirect comparison of automated indirect immunofluorescence vs automated solid-phase immunoassays for antinuclear antibody detection: A meta-analysis and adjusted indirect comparison of diagnostic test accuracy. Int J Rheum Dis 2022; 25:991-1002. [PMID: 35726725 DOI: 10.1111/1756-185x.14369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The primary aim of this study was to conduct a meta-analysis to compare the diagnostic accuracy of automated indirect immunofluorescence (automated-IIF) and fully automated solid-phase immunoassays (solid-phase assays), compared with gold standard conventional manual indirect immunofluorescence (manual-IIF) for antinuclear antibody (ANA) detection. METHODS Indirect meta-comparison was performed using prospective studies reporting comparative data between automated-IIF and fully automated solid-phase assays individually to conventional manual-IIF. Diagnostic tests regarding different automated solid-phase assays and automated-IIF for ANA detection were retrieved from the Cochrane Library, PubMed, Embase, Web of Science, Chinese Biological Medicine Database (CBM), China National Knowledge Infrastructure (CNKI), and WANFANG electronic databases from their inception to January 2022. Assessment of the quality of the studies was undertaken using a second version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The investigated diagnostic indices including pooled sensitivity, pooled specificity, pooled positive likelihood ratio (PLR), pooled negative likelihood ratio (NLR), pooled diagnostic odds ratio (DOR), area under the summary receiver operating characteristic (AUC) of automated-IIF and solid-phase assays, respectively. Relative diagnostic odds ratio (RDOR) was calculated to indirectly compare the diagnostic accuracy of automated-IIF and solid-phase assays. To visualize results, we provide forest plots showing the RDOR with 95% confidence intervals (CI) of the 2 methods against the "gold standard" manual-IIF by R software. Deeks' funnel was used to investigate the publication bias. RESULTS A total of 16 studies involving 6111 subjects were included in the analysis. The pooled sensitivity, pooled specificity, pooled PLR, pooled NLR, pooled DOR and the AUC were 0.85 (95% CI: 0.84-0.86), 0.82 (95% CI 0.81-0.84), 14.22 (95% CI 8.55-23.65), 0.06 (95% CI 0.03-0.12), 287.0 (95% CI 124.30-662.68) and 0.983 for automated-IIF respectively, and as for solid-phase assays those were 0.73 (95% CI 0.70-0.75), 0.87 (95% CI 0.85-0.89), 5.66 (95% CI 3.33-9.62), 0.30 (95% CI 0.20-0.47), 19.14 (95% CI 8.00-45.79) and 0.894. The results of indirect comparison indicated that automated-IIF had statistically significant higher accuracy for the detection of ANA. CONCLUSION This meta-analysis and indirect comparison suggest that automated-IIF should be recommended as an alternative assay for ANA screening under the condition of increased demand for ANA testing in clinical immunology laboratories.
Collapse
Affiliation(s)
- Minjie Zhang
- Department of Medical Laboratory, Xianyang Central Hospital, Xianyang, China
| | - Xiaoyan Zhang
- Department of Medical Laboratory, Yan'an People's Hospital, Yan'an, China
| |
Collapse
|