The Role of Antinuclear Antibody (ANA) Profile in Diagnosis of Systemic Lupus Erythematosus

Abstract

by The American College of Rheumatology published in 1982 and revised in 1997. Diagnosis of SLE is made if a patient satisfied 4 of 11 the criteria. 5 The criteria are malar rash, discoid rash, photosensitivity, oral ulcers, nonerosive arthritis, pleuritis or pericarditis, renal disorder, neurologic disorder, hematologic disorder, immunologic disorder, positive antinuclear antibody. DiscussionThis autoimmune disease characterized by the aberrant production of a broad and heterogenous group of autoantibodies. Autoantibodies directed to nuclear (ANAs), cytoplasmic, and cellular membrane antigens are considered the serological hallmark in SLE. ANAs consist of various types of autoantibodies characterized by different antigen specificities. These nuclear antigens include single strand (ss) and double strand (ds) DNA (deoxyribonucleic acid), histone proteins, nucleosome (histone-DNA complex), centromere proteins, and extractable nuclear antigens (ENA) (Smith antigen (Sm), Ro, La, ribonucleoprotein), etc. Common autoantibody -mediated mechanisms of damage in SLE include immune complex mediate damage, cell surface binding and cytotoxicity, reactivity with autoantigens expressed on apoptotic or activated cell surface, penetration into living cells, and binding to cross reactive extracellular molecules. Even though the presence of autoantibodies in SLE has been known, for more than 60 years, still nowadays a great effort is being made to understand the pathogenetic, diagnostic, and prognostic meaning of such Autoantibodies. 7,8The traditional methods for detecting ANA are indirect immunofluorescence (IIF) and enzyme immunoassay (ELISA).9 In general, if a patient presents clinical manifestations of an autoimmune disease, the first test to be requested is ANA detection using indirect immunofluorescence using HEp-2cells, due to its great sensitivity. The different possible patterns, the intensity, and the titers obtained by consecutive dilutions must be carefully examined, The usefulness of this testing has been evaluated in retro-spective studies of patients with systemic rheumatic disease (SRD), and it has been proven that its positive predictive value is low due to the relatively large amount of false positive results.10 ANA pattern is reffered to the pattern of nuclear fluorescence observed under fluorescence microscopy. Certain patterns of fluorescence are associated with certain nuclear antigens and specific disease. Patterns of staining provide a clue to the category of nuclear antigen involved and are dependent upon the type of substrate used, and to a certain extent, the experience of the technician. Reliance on ANA patterns has largely been replaced by identification of specific antinuclear antibodies through the ANA profile. 11ANA profile with immunoblotting or ELISA methods can detect some antibodies such as seen in Table 1. 9,12,13 Double stranded DNA antibodies (anti-dsDNA) have been considered useful and valuable in the diagnosis of SLE.1 Anti-Sm antibodies are a highly specific marker for SLE and Anti-Sm re...

Prevalence of lupus nephritis and the use of serology in a central South African chronic kidney disease patient cohort

“…Anti-nuclear antibodies (ANAs) are considered to be the serological hallmark of SLE. [15] Our results support the prominent role that ANAs have in LN disease aetiology, with 94.74% (n=36/38) of the LN study population being positive for ANA, accounting for 85.71% (n=36/42) of the entire CKD population with positive ANA, but not histologically proven LN. This translates to approximately every 8 in 10 ANA-positive individuals with CKD having LN.…”

“…Anti-dsDNA and anti-Sm antibodies are considered to be highly specific markers for SLE and are predictors of high risk for developing LN in patients with SLE. [15] However, a different type of ANA, namely anti-ribonucleoprotein (anti-RNP) antibody, which is not specific to SLE according to the ACR criteria, [5] was present in more than half (71.43%, n=20/28) of the total LN cohort with positive ANA, indicating that it may potentially be more specific to LN in our population.…”

Relation between vitamin d level and cyclin-dependent kinase-1 gene expression in egyptian patients with lupus nephritis and their impact on disease activity

“…Pathogenic role of ANA is represented by multiple mechanisms including organ damage by immune complexes deposition (Wijaya and Bahrun, 2017). [ 33 ]…”