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Freudenhammer M, Salzer U, Heselich A, Hufnagel M, Janda A. Low Prevalence of Anti-DFS70 Antibodies in Children With ANA-Associated Autoimmune Disease. Front Pediatr 2022; 10:839928. [PMID: 35391747 PMCID: PMC8980602 DOI: 10.3389/fped.2022.839928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Anti-DFS70 antibodies occur in healthy individuals with various medical conditions. Unlike other anti-nuclear autoantibodies (ANA), they are not associated with systemic autoimmune disease in adult patients. To date, only a few studies have addressed the prevalence and/or clinical relevance of anti-DFS70 autoantibodies in children with and without autoimmune disease. METHODS Included in this retrospective cross-sectional mono-centric study were 308 pediatric patients with suspected or known autoimmune conditions who had a positive ANA in indirect immune fluorescence (IIF) screening and who were screened for anti-DFS70 antibodies by extractable nuclear antigen antibodies (ENA) immunoblot. Patients were assigned to four different diagnostic categories according to their diagnosis in the corresponding medical record: (a) absence of autoimmune or rheumatic disease (noARD, n = 116); (b) suspected autoimmunity without definitive diagnosis (sAI, n = 48); (c) other rheumatic disease (ORD) (n = 115); and (d) ANA-associated autoimmune disease (AARD, n = 29). RESULTS The prevalence of anti-DFS70 antibodies in the overall cohort was 33.8%. Among children without ARD (46.6%, 54/116), prevalence was significantly higher than among children with ORD (23.7%, 27/115, p = 0.0003) or AARD (17.2%, 5/29, p = 0.0054). Among all of the anti-DFS70 positive patients with AARD, other autoantibodies were found in the ENA immunoblot. In contrast, among anti-DFS70 positive patients with ORD (11.5%, 4/27), sAI (33.3%, 6/18) and noARD (16.7%, 9/54), other autoantibodies infrequently were detected (p = 0.0005). Patients with uveitis rarely were positive for anti-DFS70 antibodies (7.7%, 1/13). No association was found between anti-DFS70 antibodies and a history of allergic conditions (p = 0.51). The concordance between a typical DFS pattern in IIF and the detection of anti-DFS70 antibodies by immunoblot was 59.3%. CONCLUSION As with adults, the higher prevalence of anti-DFS70 among children without autoimmune disease confirms the mutual exclusion for this autoantibody in the pathogenesis of ARD. Among ANA-positive children, monospecific anti-DFS70 antibodies may help to discriminate between AARD and not-AARD-related conditions.
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Affiliation(s)
- Mirjam Freudenhammer
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Chronic Immunodeficiency, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,IMM-PACT Clinician Scientist Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrich Salzer
- Center for Chronic Immunodeficiency, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Rheumatology and Clinical Immunology, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Aileen Heselich
- Center for Chronic Immunodeficiency, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Markus Hufnagel
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ales Janda
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
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Carbone T, Picerno V, Pafundi V, Esposito E, Leccese P, Padula AA, D'Angelo S. Impact of the COVID-19 Pandemic on the Appropriateness of Diagnostic Pathways of Autoimmune Rheumatic Diseases. J Rheumatol 2021; 49:219-224. [PMID: 34654735 DOI: 10.3899/jrheum.210611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Early diagnosis of autoimmune rheumatic diseases (ARDs) is key to achieving effective treatment and improving prognosis. The coronavirus disease 2019 (COVID-19) pandemic has led to major changes in clinical practice on a global scale. We aimed to evaluate the impact of the COVID-19 pandemic on rheumatological clinical practice and autoimmunity testing demands. METHODS Data regarding the first rheumatological visits and new diagnoses, together with the autoimmunity laboratory testing volumes related to the COVID-19 pandemic phase (January-December 2020), were collected from medical records and the laboratory information system of a regional reference hospital (Basilicata, Italy) and compared with those obtained during the corresponding period in 2019. RESULTS A significant decrease in the 2020 autoimmunity laboratory test volume was found when compared with the same period in 2019 (9912 vs 14,100; P < 0.05). A significant decrease in first rheumatological visits and diagnosis (1272 vs 2336; P < 0.05) was also observed. However, an equivalent or higher percentage of positive autoimmunity results from outpatient services was recorded during 2020 when compared to the prepandemic state. Of note, COVID-19-associated decline in new diagnoses affected mainly less severe diseases. In contrast, ARDs with systemic involvement were diagnosed at the same levels as in the prepandemic period. CONCLUSION The COVID-19 pandemic has affected access to health services. However, our study highlighted that during the outbreak, greater appropriateness of the requests for laboratory tests and visits emerged, as shown by a greater percentage of positive test results and new diagnoses of more severe ARDs compared to the prepandemic period.
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Affiliation(s)
- Teresa Carbone
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Valentina Picerno
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Vito Pafundi
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Ernesto Esposito
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Pietro Leccese
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Angela Anna Padula
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Salvatore D'Angelo
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
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Pashnina IA, Krivolapova IM, Fedotkina TV, Ryabkova VA, Chereshneva MV, Churilov LP, Chereshnev VA. Antinuclear Autoantibodies in Health: Autoimmunity Is Not a Synonym of Autoimmune Disease. Antibodies (Basel) 2021; 10:9. [PMID: 33668697 PMCID: PMC8006153 DOI: 10.3390/antib10010009] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/26/2020] [Accepted: 02/07/2021] [Indexed: 12/11/2022] Open
Abstract
The incidence of autoimmune diseases is increasing. Antinuclear antibody (ANA) testing is a critical tool for their diagnosis. However, ANA prevalence in healthy persons has increased over the last decades, especially among young people. ANA in health occurs in low concentrations, with a prevalence up to 50% in some populations, which demands a cutoff revision. This review deals with the origin and probable physiological or compensatory function of ANA in health, according to the concept of immunological clearance, theory of autoimmune regulation of cell functions, and the concept of functional autoantibodies. Considering ANA titers ≤1:320 as a serological marker of autoimmune diseases seems inappropriate. The role of anti-DFS70/LEDGFp75 autoantibodies is highlighted as a possible anti-risk biomarker for autoimmune rheumatic disorders. ANA prevalence in health is different in various regions due to several underlying causes discussed in the review, all influencing additive combinations according to the concept of the mosaic of autoimmunity. Not only are titers, but also HEp-2 IFA) staining patterns, such as AC-2, important. Accepting autoantibodies as a kind of bioregulator, not only the upper, but also the lower borders of their normal range should be determined; not only their excess, but also a lack of them or "autoimmunodeficiency" could be the reason for disorders.
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Affiliation(s)
- Irina A. Pashnina
- Regional Children’s Clinical Hospital, 620149 Yekaterinburg, Russia;
| | - Irina M. Krivolapova
- Regional Children’s Clinical Hospital, 620149 Yekaterinburg, Russia;
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (M.V.C.); (V.A.C.)
| | - Tamara V. Fedotkina
- Laboratory of the Mosaics of Autoimmunity, Saint Petersburg State University, 199034 Saint Petersburg, Russia; (T.V.F.); (V.A.R.); (L.P.C.)
| | - Varvara A. Ryabkova
- Laboratory of the Mosaics of Autoimmunity, Saint Petersburg State University, 199034 Saint Petersburg, Russia; (T.V.F.); (V.A.R.); (L.P.C.)
| | - Margarita V. Chereshneva
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (M.V.C.); (V.A.C.)
| | - Leonid P. Churilov
- Laboratory of the Mosaics of Autoimmunity, Saint Petersburg State University, 199034 Saint Petersburg, Russia; (T.V.F.); (V.A.R.); (L.P.C.)
- Saint Petersburg Research Institute of Phthisiopulmonology, 191036 Saint Petersburg, Russia
| | - Valeriy A. Chereshnev
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (M.V.C.); (V.A.C.)
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