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2018 ; 5
(ä): 88
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Recognition and Relevance of Anti-DFS70 Autoantibodies in Routine Antinuclear
Autoantibodies Testing at a Community Hospital
#MMPMID29686987
Carter JB
; Carter S
; Saschenbrecker S
; Goeckeritz BE
Front Med (Lausanne)
2018[]; 5
(ä): 88
PMID29686987
show ga
Antinuclear autoantibodies (ANA) displaying a dense fine speckled pattern (DFS,
ICAP AC-2) on HEp-2 cells are frequently observed in clinical laboratory
referrals, often associated with anti-DFS70 specificity. Anti-DFS70 positive
patients rarely develop systemic autoimmune rheumatic disease (SARD), especially
in the absence of clinical evidence or additional anti-extractable nuclear
antigen (ENA) antibodies, prompting suggestions that an isolated DFS70-specific
ENA may be an exclusionary finding for SARD. In this study, the frequency and
diagnostic significance of anti-DFS70 autoantibodies was investigated in a
community hospital cohort of patients undergoing routine ANA testing. ANA
screening was performed by HEp-20-10-based indirect immunofluorescence, followed
by ENA profiling using a multiparametric line immunoassay (LIA). Of 6,511 patient
samples tested for ANA in 2016, the DFS pattern was identified in 1,758 (27.0%),
720 (41.0%) of which were anti-DFS70 positive by LIA. Of these, 526 (73.1%)
revealed isolated anti-DFS70 reactivity, while 194 (26.9%) showed additional ENA
specificities. Among 1,038 anti-DFS70 negative or borderline samples, 778 (75.0%)
were ENA profile negative, while the remaining 260 (25.0%) showed a varied
presence of other ENA specificities. Chart reviews of patients with an isolated
anti-DFS70 ANA affirmed that ANA-related SARD is rare in the absence of clinical
evidence or other ENA specificities, there being no case thus far identified.
Rheumatoid arthritis patients occasionally had an isolated anti-DFS70 ANA and
were positive for rheumatoid factor and anti-cyclic citrullinated peptide
antibodies. In conclusion, the recognition of a DFS ANA pattern using a
mitotic-rich HEp-2 substrate, followed by confirmation of anti-DFS70 specificity
should be a routine ANA testing service. Use of an expanded ENA profile and
clinical correlation is necessary to affirm the "isolation" of anti-DFS70 as the
cause of an ANA. Recognition of isolated anti-DFS70 ANA enables reassurance of
patients that SARD is unlikely, thus avoiding referral for more extensive
testing. The presence of significant elevations of other ENAs may reflect SARD
and warrants close clinical correlation and follow-up.