Abstract
Anti-DFS70 antibodies have been proposed as a marker to exclude systemic autoimmune rheumatic disease (SARD). We conducted this systematic diagnostic test accuracy review and meta-analysis to determine the performance of anti-DFS70 antibodies in patients with a positive anti-nuclear antibody (ANA) test result to exclude SARD. We searched PubMed, Embase, Web of Science, Scopus and the Cochrane Library up to 22 February 2021, and included studies examining the diagnostic accuracy of anti-DFS70 antibodies in patients with a positive ANA test result. The results were pooled using a hierarchical bivariate model and plotted in summary receiver operating characteristic curves. R software and Stata Statistical Software were used for the statistical analysis. Eight studies with 4168 patients were included. The summary sensitivity was 0.19 (95% confidence interval: 0.12–0.28) and the specificity was 0.93 (95% confidence interval: 0.88–0.96). The area under the curve was 0.69 (95% confidence interval: 0.64–0.72). The meta-regression analysis showed that targeting only ANA-associated rheumatic disease was associated with higher specificity. In addition, the studies with a non-SARD prevalence of <80% and using a chemiluminescence assay were associated with higher specificity. Anti-DFS70 antibodies have high specificity for the exclusion of SARD among patients presenting with a positive ANA test, but the sensitivity is low.
Highlights
Anti-nuclear antibodies (ANAs) have a crucial role in the diagnosis of systemic autoimmune rheumatic disease (SARD)
Previous studies have shown that anti-DFS70 antibodies are commonly found in the serum of healthy people [1,8,9], and that in contrast to other autoantibodies associated with specific autoimmune diseases, anti-DFS70 antibodies may not be associated with SARD
The following data were extracted into an electronic table and assessed by C.F.C. and T.Y.L.: the first author’s name, year of publication, number of patients, ANA titer at enrollment in the study, method of detecting anti-DFS70 antibodies, reference standard for SARD, and number of true positive (TP), false negative (FN), true negative (TN) and false positive (FP) participants
Summary
Anti-nuclear antibodies (ANAs) have a crucial role in the diagnosis of systemic autoimmune rheumatic disease (SARD). A recent meta-analysis focusing on the diagnostic performance of anti-DFS70 antibodies among patients presenting with a DFS pattern in an ANA test found substantial heterogeneity in both the sensitivity and specificity [15]. Focusing on studies enrolling patients presenting with a positive ANA test, rather than a DFS pattern, for metaanalysis may decrease the heterogeneity between studies and increase the applicability of their results. We conducted this systematic diagnostic test accuracy review and meta-analysis to determine the performance of anti-DFS70 antibodies in excluding SARD for patients presenting with a positive ANA test
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