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Zanussi JT, Zhao J, Wei WQ, Karakoc G, Chung CP, Feng Q, Olsen NJ, Stein CM, Kawai VK. Clinical diagnoses associated with a positive antinuclear antibody test in patients with and without autoimmune disease. BMC Rheumatol 2023; 7:24. [PMID: 37550754 PMCID: PMC10405518 DOI: 10.1186/s41927-023-00349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Antinuclear antibodies (ANA) are antibodies present in several autoimmune disorders. However, a large proportion of the general population (20%) also have a positive test; very few of these individuals will develop an autoimmune disease, and the clinical impact of a positive ANA in them is not known. Thus, we test the hypothesis that ANA + test reflects a state of immune dysregulation that alters risk for some clinical disorders in individuals without an autoimmune disease. METHODS We performed high throughput association analyses in a case-control study using real world data from the de-identified electronic health record (EHR) system from Vanderbilt University Medical Center. The study population included individuals with an ANA titer ≥ 1:80 at any time (ANA +) and those with negative results (ANA-). The cohort was stratified into sub-cohorts of individuals with and without an autoimmune disease. A phenome-wide association study (PheWAS) adjusted by sex, year of birth, race, and length of follow-up was performed in the study cohort and in the sub-cohorts. As secondary analyses, only clinical diagnoses after ANA testing were included in the analyses. RESULTS The cohort included 70,043 individuals: 49,546 without and 20,497 with an autoimmune disease, 26,579 were ANA + and 43,464 ANA-. In the study cohort and the sub-cohort with autoimmune disease, ANA + was associated (P ≤ 5 × 10-5) with 88 and 136 clinical diagnoses respectively, including lupus (OR ≥ 5.4, P ≤ 7.8 × 10-202) and other autoimmune diseases and complications. In the sub-cohort without autoimmune diseases, ANA + was associated with increased risk of Raynaud's syndrome (OR ≥ 2.1) and alveolar/perialveolar-related pneumopathies (OR ≥ 1.4) and decreased risk of hepatitis C, tobacco use disorders, mood disorders, convulsions, fever of unknown origin, and substance abuse disorders (OR ≤ 0.8). Analyses including only diagnoses after ANA testing yielded similar results. CONCLUSION A positive ANA test, in addition to known associations with autoimmune diseases, Raynaud's phenomenon, and idiopathic fibrosing alveolitis related disorders, is associated with decreased prevalence of several non-autoimmune diseases.
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Affiliation(s)
- Jacy T Zanussi
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Juan Zhao
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Gul Karakoc
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cecilia P Chung
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN, USA
- Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Valley Healthcare System - Nashville Campus, Nashville, TN, USA
| | - QiPing Feng
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nancy J Olsen
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - C Michael Stein
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Vivian K Kawai
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN, USA.
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Rattay TW, Martin P, Vittore D, Hengel H, Cebi I, Tünnerhoff J, Stefanou MI, Hoffmann JF, von der Ehe K, Klaus J, Vonderschmitt J, Herrmann ML, Bombach P, Al Barazi H, Zeltner L, Richter J, Hesse K, Eckstein KN, Klingberg S, Wildgruber D. Cerebrospinal fluid findings in patients with psychotic symptoms-a retrospective analysis. Sci Rep 2021; 11:7169. [PMID: 33785807 PMCID: PMC8010098 DOI: 10.1038/s41598-021-86170-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/10/2021] [Indexed: 12/14/2022] Open
Abstract
In current international classification systems (ICD-10, DSM5), the diagnostic criteria for psychotic disorders (e.g. schizophrenia and schizoaffective disorder) are based on symptomatic descriptions since no unambiguous biomarkers are known to date. However, when underlying causes of psychotic symptoms, like inflammation, ischemia, or tumor affecting the neural tissue can be identified, a different classification is used ("psychotic disorder with delusions due to known physiological condition" (ICD-10: F06.2) or psychosis caused by medical factors (DSM5)). While CSF analysis still is considered optional in current diagnostic guidelines for psychotic disorders, CSF biomarkers could help to identify known physiological conditions. In this retrospective, partly descriptive analysis of 144 patients with psychotic symptoms and available CSF data, we analyzed CSF examinations' significance to differentiate patients with specific etiological factors (F06.2) from patients with schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F2). In 40.3% of all patients, at least one CSF parameter was out of the reference range. Abnormal CSF-findings were found significantly more often in patients diagnosed with F06.2 (88.2%) as compared to patients diagnosed with F2 (23.8%, p < 0.00001). A total of 17 cases were identified as probably caused by specific etiological factors (F06.2), of which ten cases fulfilled the criteria for a probable autoimmune psychosis linked to the following autoantibodies: amphiphysin, CASPR2, CV2, LGl1, NMDA, zic4, and titin. Two cases presented with anti-thyroid tissue autoantibodies. In four cases, further probable causal factors were identified: COVID-19, a frontal intracranial tumor, multiple sclerosis (n = 2), and neurosyphilis. Twenty-one cases remained with "no reliable diagnostic classification". Age at onset of psychotic symptoms differed between patients diagnosed with F2 and F06.2 (p = 0.014), with the latter group being older (median: 44 vs. 28 years). Various CSF parameters were analyzed in an exploratory analysis, identifying pleocytosis and oligoclonal bands (OCBs) as discriminators (F06.2 vs. F2) with a high specificity of > 96% each. No group differences were found for gender, characteristics of psychotic symptoms, substance dependency, or family history. This study emphasizes the great importance of a detailed diagnostic workup in diagnosing psychotic disorders, including CSF analysis, to detect possible underlying pathologies and improve treatment decisions.
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Affiliation(s)
- Tim W Rattay
- Department of Neurodegenerative Disease, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany.
- German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany.
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.
- Center for Rare Diseases (ZSE), Tübingen, Germany.
| | - Pascal Martin
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Tübingen, Germany
| | - Debora Vittore
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Holger Hengel
- Department of Neurodegenerative Disease, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany
- German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- Center for Rare Diseases (ZSE), Tübingen, Germany
| | - Idil Cebi
- Department of Neurodegenerative Disease, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Johannes Tünnerhoff
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- Department for General Neurology and Stroke, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Tübingen, Germany
| | - Maria-Ioanna Stefanou
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- Department for General Neurology and Stroke, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Tübingen, Germany
| | - Jonatan F Hoffmann
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Katrin von der Ehe
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Johannes Klaus
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Julia Vonderschmitt
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Matthias L Herrmann
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- Department of Neurology and Neuroscience, Medical Center, University of Freiburg, Breisgau, Germany
| | - Paula Bombach
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Hazar Al Barazi
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Lena Zeltner
- Department of Neurodegenerative Disease, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany
- Center for Rare Diseases (ZSE), Tübingen, Germany
| | - Janina Richter
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Kathrin N Eckstein
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Dirk Wildgruber
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
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Sæther SG, Rø ADB, Larsen JB, Vaaler A, Kondziella D, Reitan SK. Biomarkers of Autoimmunity in Acute Psychiatric Disorders. J Neuropsychiatry Clin Neurosci 2020; 31:246-253. [PMID: 30888921 DOI: 10.1176/appi.neuropsych.18040069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Previous studies have suggested that autoantibodies associated with systemic autoimmune disorders are more prevalent in patients with psychotic and affective disorders compared with healthy control subjects. However, most positive studies addressing this issue have been limited by small sample sizes and lack of correction for confounding factors. The authors aimed to assess the prevalence of several autoantibodies in patients admitted to acute psychiatric inpatient care and investigate whether patients with psychotic and affective disorders have an increased prevalence of autoantibodies compared with psychiatric patients admitted for other reasons. METHODS Five hundred eighty-five patients were screened for the presence of antinuclear antibodies (ANA), anticardiolipin and antibeta2-glycoprotein, antithyroid peroxidase (anti-TPO), antitissue transglutaminase IgA, antigliadin deamidated peptide IgG, and rheumatoid factor IgM (RF). Differences in prevalence between patients with nonaffective psychoses (N=105), bipolar disorders (N=78), unipolar depressive disorders (N=146), and other reasons for admission (N=256) were assessed using chi-square tests and logistic regression models. RESULTS One or more autoantibodies were present in 26.2% of the patients, including ANA (9.4%), RF (9.2%), and anti-TPO (5.6%). Autoantibody prevalence increased with age (odds ratio=1.21, 95% CI=1.09-1.35) and smoking status (odds ratio=1.99, 95% CI=1.04-3.82) but was not associated with a diagnosis of a psychotic or affective disorder. CONCLUSIONS Autoimmune autoantibodies seem to be equally prevalent in patients with acute psychiatric conditions with and without psychotic and affective disorders. This result challenges the idea that these autoantibodies have specificity for certain psychiatric disorders.
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Affiliation(s)
- Sverre Georg Sæther
- The St. Olavs Hospital, Trondheim University Hospital, Division of Mental Health Care, Trondheim, Norway (Sæther, Larsen, Vaaler, Reitan); the Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Department of Mental Health, Trondheim, Norway (Sæther, Larsen, Vaaler, Kondziella, Reitan); the St. Olav's Hospital, Trondheim University Hospital, Department of Immunology and Transfusion Medicine, Trondheim, Norway (Rø); the Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Department of Public Health and Nursing, Trondheim, Norway (Rø); the Rigshospitalet, Copenhagen University Hospital, Department of Neurology, Copenhagen, Denmark (Kondziella), and the University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark (Kondziella)
| | - Anne Dorthea Bjerkenes Rø
- The St. Olavs Hospital, Trondheim University Hospital, Division of Mental Health Care, Trondheim, Norway (Sæther, Larsen, Vaaler, Reitan); the Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Department of Mental Health, Trondheim, Norway (Sæther, Larsen, Vaaler, Kondziella, Reitan); the St. Olav's Hospital, Trondheim University Hospital, Department of Immunology and Transfusion Medicine, Trondheim, Norway (Rø); the Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Department of Public Health and Nursing, Trondheim, Norway (Rø); the Rigshospitalet, Copenhagen University Hospital, Department of Neurology, Copenhagen, Denmark (Kondziella), and the University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark (Kondziella)
| | - Jeanette Brun Larsen
- The St. Olavs Hospital, Trondheim University Hospital, Division of Mental Health Care, Trondheim, Norway (Sæther, Larsen, Vaaler, Reitan); the Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Department of Mental Health, Trondheim, Norway (Sæther, Larsen, Vaaler, Kondziella, Reitan); the St. Olav's Hospital, Trondheim University Hospital, Department of Immunology and Transfusion Medicine, Trondheim, Norway (Rø); the Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Department of Public Health and Nursing, Trondheim, Norway (Rø); the Rigshospitalet, Copenhagen University Hospital, Department of Neurology, Copenhagen, Denmark (Kondziella), and the University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark (Kondziella)
| | - Arne Vaaler
- The St. Olavs Hospital, Trondheim University Hospital, Division of Mental Health Care, Trondheim, Norway (Sæther, Larsen, Vaaler, Reitan); the Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Department of Mental Health, Trondheim, Norway (Sæther, Larsen, Vaaler, Kondziella, Reitan); the St. Olav's Hospital, Trondheim University Hospital, Department of Immunology and Transfusion Medicine, Trondheim, Norway (Rø); the Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Department of Public Health and Nursing, Trondheim, Norway (Rø); the Rigshospitalet, Copenhagen University Hospital, Department of Neurology, Copenhagen, Denmark (Kondziella), and the University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark (Kondziella)
| | - Daniel Kondziella
- The St. Olavs Hospital, Trondheim University Hospital, Division of Mental Health Care, Trondheim, Norway (Sæther, Larsen, Vaaler, Reitan); the Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Department of Mental Health, Trondheim, Norway (Sæther, Larsen, Vaaler, Kondziella, Reitan); the St. Olav's Hospital, Trondheim University Hospital, Department of Immunology and Transfusion Medicine, Trondheim, Norway (Rø); the Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Department of Public Health and Nursing, Trondheim, Norway (Rø); the Rigshospitalet, Copenhagen University Hospital, Department of Neurology, Copenhagen, Denmark (Kondziella), and the University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark (Kondziella)
| | - Solveig Klæbo Reitan
- The St. Olavs Hospital, Trondheim University Hospital, Division of Mental Health Care, Trondheim, Norway (Sæther, Larsen, Vaaler, Reitan); the Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Department of Mental Health, Trondheim, Norway (Sæther, Larsen, Vaaler, Kondziella, Reitan); the St. Olav's Hospital, Trondheim University Hospital, Department of Immunology and Transfusion Medicine, Trondheim, Norway (Rø); the Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Department of Public Health and Nursing, Trondheim, Norway (Rø); the Rigshospitalet, Copenhagen University Hospital, Department of Neurology, Copenhagen, Denmark (Kondziella), and the University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark (Kondziella)
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