Clinical significance of antinuclear antibodies in primary immune thrombocytopenia

Abstract

SummaryThere are discrepancies across guidelines about whether the dosage of antinuclear antibodies (ANAs) is of use at the diagnosis of primary immune thrombocytopenia (ITP). This review describes the current knowledge about ANA prevalence in patients with primary ITP, and their potential usefulness as biomarkers for ITP evolution, response to treatments and increased risk of subsequent development of systemic lupus and thrombosis.

Excellent response to treatment with hydroxychloroquine in pediatric patients with SLE‐related immune thrombocytopenia

“…Most patients initially respond to first‐line ITP therapy, mainly comprised of IVIg and glucocorticoids, but due to the temporality of the response and side effects, other treatment options are needed 14,22,33 . HCQ is a commonly used immunomodulatory drug for the treatment of SLE 17,22,26–30 . Studies suggested that it may serve as an effective option for adult patients with SLE‐related thrombocytopenia and children with ITP and positive autoimmune markers 27–31,38 .…”

“…14,22,33 HCQ is a commonly used immunomodulatory drug for the treatment of SLE. 17,22,[26][27][28][29][30] Studies suggested that it may serve as an effective option for adult patients with SLE-related thrombocytopenia and children with ITP and positive autoimmune markers. [27][28][29][30][31]38 In this study, we showed that children with ITP and positive ANA titer who have partial or complete SLE criteria may benefit from treatment with HCQ.…”

“…The significance of a positive ANA test in primary non‐SLE ITP is still inconclusive. However, positive ANA was associated with a higher risk for chronic ITP and a nonresponsive disease in both pediatric and adult ITP 15–18 …”

“…However, positive ANA was associated with a higher risk for chronic ITP and a nonresponsive disease in both pediatric and adult ITP. [15][16][17][18] Adult patients with SLE-associated ITP who do not respond to firstline therapies (i.e., glucocorticoids, anti-Rho (D) immune globulin, or intravenous immunoglobulins) are offered treatment with rituximab, splenectomy, danazol, or immunosuppressive drugs. [19][20][21][22] Hydroxychloroquine (HCQ), originally an antimalarial drug, has various immunomodulatory effects and plays an essential role in the treatment of SLE.…”