Longitudinal analysis of ANA in the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort.
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Author
Choi, May YeeClarke, Ann Elaine
Urowitz, Murray
Hanly, John
St-Pierre, Yvan
Gordon, Caroline
Bae, Sang-Cheol
Romero-Diaz, Juanita
Sanchez-Guerrero, Jorge
Bernatsky, Sasha
Wallace, Daniel J
Isenberg, David
Rahman, Anisur
Merrill, Joan T
Fortin, Paul R
Gladman, Dafna D
Bruce, Ian N
Petri, Michelle
Ginzler, Ellen M
Dooley, Mary Anne
Ramsey-Goldman, Rosalind
Manzi, Susan
Jönsen, Andreas
Alarcón, Graciela S
van Vollenhoven, Ronald F
Aranow, Cynthia
Mackay, Meggan
Ruiz-Irastorza, Guillermo
Lim, Sam
Inanc, Murat
Kalunian, Ken
Jacobsen, Søren
Peschken, Christine
Kamen, Diane L
Askanase, Anca
Buyon, Jill P
Costenbader, Karen H
Fritzler, Marvin J
Journal title
Annals of the rheumatic diseasesDate Published
2022-03-25Publication Volume
81Publication Issue
8Publication Begin page
1143Publication End page
1150
Metadata
Show full item recordAbstract
A perception derived from cross-sectional studies of small systemic lupus erythematosus (SLE) cohorts is that there is a marked discrepancy between antinuclear antibody (ANA) assays, which impacts on clinicians' approach to diagnosis and follow-up. We compared three ANA assays in a longitudinal analysis of a large international incident SLE cohort retested regularly and followed for 5 years.Demographic, clinical and serological data was from 805 SLE patients at enrolment, year 3 and 5. Two HEp-2 indirect immunofluorescence assays (IFA1, IFA2), an ANA ELISA, and SLE-related autoantibodies were performed in one laboratory. Frequencies of positivity, titres or absorbance units (AU), and IFA patterns were compared using McNemar, Wilcoxon and kappa statistics, respectively.
At enrolment, ANA positivity (≥1:80) was 96.1% by IFA1 (median titre 1:1280 (IQR 1:640-1:5120)), 98.3% by IFA2 (1:2560 (IQR 1:640-1:5120)) and 96.6% by ELISA (176.3 AU (IQR 106.4 AU-203.5 AU)). At least one ANA assay was positive for 99.6% of patients at enrolment. At year 5, ANA positivity by IFAs (IFA1 95.2%; IFA2 98.9%) remained high, while there was a decrease in ELISA positivity (91.3%, p<0.001). Overall, there was >91% agreement in ANA positivity at all time points and ≥71% agreement in IFA patterns between IFA1 and IFA2.
In recent-onset SLE, three ANA assays demonstrated commutability with a high proportion of positivity and titres or AU. However, over 5 years follow-up, there was modest variation in ANA assay performance. In clinical situations where the SLE diagnosis is being considered, a negative test by either the ELISA or HEp-2 IFA may require reflex testing.
Citation
Choi MY, Clarke AE, Urowitz M, Hanly J, St-Pierre Y, Gordon C, Bae SC, Romero-Diaz J, Sanchez-Guerrero J, Bernatsky S, Wallace DJ, Isenberg D, Rahman A, Merrill JT, Fortin PR, Gladman DD, Bruce IN, Petri M, Ginzler EM, Dooley MA, Ramsey-Goldman R, Manzi S, Jönsen A, Alarcón GS, van Vollenhoven RF, Aranow C, Mackay M, Ruiz-Irastorza G, Lim S, Inanc M, Kalunian K, Jacobsen S, Peschken C, Kamen DL, Askanase A, Buyon JP, Costenbader KH, Fritzler MJ. Longitudinal analysis of ANA in the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort. Ann Rheum Dis. 2022 Aug;81(8):1143-1150. doi: 10.1136/annrheumdis-2022-222168. Epub 2022 Mar 25. PMID: 35338033.DOI
10.1136/annrheumdis-2022-222168ae974a485f413a2113503eed53cd6c53
10.1136/annrheumdis-2022-222168
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- Creative Commons
Except where otherwise noted, this item's license is described as © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
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