Pattern on the antinuclear antibody–HEp‐2 test is a critical parameter for discriminating antinuclear antibody–positive healthy individuals and patients with autoimmune rheumatic diseases

• Published in: Arthritis & rheumatology (Hoboken, N.J.) Vol. 63; no. 1; pp. 191 - 200
• Main Authors: Mariz, Henrique A., Sato, Emília I., Barbosa, Silvia H., Rodrigues, Silvia H., Dellavance, Alessandra, Andrade, Luis E. C.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-01-2011; Wiley; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Age Factors; Aged; Antibodies, Antinuclear - immunology; Antinuclear antibodies; Autoimmune Diseases - diagnosis; Autoimmune Diseases - immunology; Biological and medical sciences; Blotting, Western; Diseases of the osteoarticular system; Female; Humans; Immune system; Male; Medical research; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Rheumatic diseases; Rheumatic Diseases - diagnosis; Rheumatic Diseases - immunology; ROC Curve; Statistics, Nonparametric; Surveys and Questionnaires; Human; Immunopathology; Autoimmune disease; Rheumatism; Diseases of the osteoarticular system; Rheumatology
• ISSN: 0004-3591; 2326-5191; 1529-0131; 1529-0131; 2326-5205
• DOI: 10.1002/art.30084

Objective
To identify features of antinuclear antibody (ANA)–HEp‐2 test results that discriminate ANA‐positive healthy individuals and patients with autoimmune rheumatic diseases (ARDs).
Methods
We sequentially retrieved data on 918 healthy individuals and 153 patients with ARDs after clinical assessment. ANA‐positive healthy individuals for whom data were available were reevaluated after 3.6–5.0 years. An ANA–HEp‐2 test result was considered positive when a clear ANA pattern was observed at 1:80 dilution in 2 distinct commercial HEp‐2 slides by 2 blinded independent observers.
Results
ANAs were present in 118 healthy individuals (12.9%) and 138 patients with ARDs (90.2%). The ANA titer was higher in patients with ARDs than in healthy individuals (P < 0.001). The ANA pattern profile was distinct in the 2 groups. Nuclear homogeneous, nuclear coarse speckled, and nuclear centromeric patterns appeared exclusively in patients with ARDs. The nuclear dense fine speckled pattern occurred only in healthy individuals. The most frequent ANA pattern in both groups was the nuclear fine speckled pattern, which occurred at lower titer in healthy individuals than in patients with ARDs (P < 0.001). Anti–extractable nuclear antigen was present in 1 healthy individual (anti‐SSA/Ro) and in 52 patients with ARDs (37.7%). None of the 40 reevaluated healthy individuals developed ARDs, and 29 (72.5%) remained ANA positive. All healthy individuals who became ANA negative had an ANA titer of 1:80 at baseline.
Conclusion
Our findings suggest that the titer, and especially the pattern, on the ANA–HEp‐2 test strongly enhances our ability to discriminate ANA‐positive healthy individuals and patients with ARDs.