Measurement and clinical significance of antinuclear antibodies
- Donald B Bloch, MD
Donald B Bloch, MD
- Associate Professor of Medicine
- Harvard Medical School
The detection of antinuclear antibodies (ANA) in serum facilitates the diagnosis of patients with systemic lupus erythematosus (SLE) and related autoimmune diseases. Conversely, the absence of ANA in the serum of a patient with suspected SLE also provides important information in that it makes the diagnosis much less likely. This topic will review:
●The indirect immunofluorescence test for ANA
●The significance of common ANA staining patterns and titer of ANA
●Additional techniques to detect ANA
●Advantages and disadvantages of methods to detect ANA
- Tan EM, Feltkamp TE, Smolen JS, et al. Range of antinuclear antibodies in "healthy" individuals. Arthritis Rheum 1997; 40:1601.
- Pollock W, Toh BH. Routine immunofluorescence detection of Ro/SS-A autoantibody using HEp-2 cells transfected with human 60 kDa Ro/SS-A. J Clin Pathol 1999; 52:684.
- Mahler M, Ngo JT, Schulte-Pelkum J, et al. Limited reliability of the indirect immunofluorescence technique for the detection of anti-Rib-P antibodies. Arthritis Res Ther 2008; 10:R131.
- Agmon-Levin N, Damoiseaux J, Kallenberg C, et al. International recommendations for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies. Ann Rheum Dis 2014; 73:17.
- http://admin.mabiotech.com/Produits/products/Brochure/AtheNA_Brochure.pdf (Accessed on June 26, 2014).
- Zheng W, He L. Multiplexed immunoassays. In: Advances in Immunoassay Technology, Chiu NHL, Christopoulos TK (Eds), InTech, 2012.
- Bruner BF, Guthridge JM, Lu R, et al. Comparison of autoantibody specificities between traditional and bead-based assays in a large, diverse collection of patients with systemic lupus erythematosus and family members. Arthritis Rheum 2012; 64:3677.
- Op De Beéck K, Vermeersch P, Verschueren P, et al. Antinuclear antibody detection by automated multiplex immunoassay in untreated patients at the time of diagnosis. Autoimmun Rev 2012; 12:137.
- Meroni PL, Schur PH. ANA screening: an old test with new recommendations. Ann Rheum Dis 2010; 69:1420.
- http://www.rheumatology.org/practice/ana_position_stmt.pdf (Accessed on December 03, 2013).
- Solomon DH, Kavanaugh AJ, Schur PH, American College of Rheumatology Ad Hoc Committee on Immunologic Testing Guidelines. Evidence-based guidelines for the use of immunologic tests: antinuclear antibody testing. Arthritis Rheum 2002; 47:434.
- Shiel WC Jr, Jason M. The diagnostic associations of patients with antinuclear antibodies referred to a community rheumatologist. J Rheumatol 1989; 16:782.
- Slater CA, Davis RB, Shmerling RH. Antinuclear antibody testing. A study of clinical utility. Arch Intern Med 1996; 156:1421.
- Maddison PJ, Stephens C, Briggs D, et al. Connective tissue disease and autoantibodies in the kindreds of 63 patients with systemic sclerosis. The United Kingdom Systemic Sclerosis Study Group. Medicine (Baltimore) 1993; 72:103.
- Arbuckle MR, McClain MT, Rubertone MV, et al. Development of autoantibodies before the clinical onset of systemic lupus erythematosus. N Engl J Med 2003; 349:1526.
- TECHNIQUES TO DETECT ANA
- Indirect immunofluorescence test for ANA
- - Significance of ANA staining patterns
- - Significance of ANA titer
- Solid phase assays
- ADVANTAGES AND DISADVANTAGES OF METHODS TO DETECT ANA
- Indirect immunofluorescence test
- Solid phase assays
- CLINICAL LIMITATIONS OF ANA TESTING
- INDICATIONS FOR ORDERING ADDITIONAL, SPECIFIC TESTS FOR AUTOANTIBODIES
- THE SIGNIFICANCE OF A POSITIVE TEST FOR ANA IN THE AS-YET UNDIAGNOSED PATIENT WITH MUSCULOSKELETAL SYMPTOMS
- SUMMARY AND RECOMMENDATIONS