Antinuclear antibodies: A marker associated with steroid-dependence in patients with Ulcerative Colitis

Abstract

The autoimmune phenomena and the autoantibody profile have acquired a great importance in ulcerative colitis (UC). Few studies have explored antinuclear antibodies' (ANA) prevalence, but not its association with steroid dependence. We hypothesized that ANA could be a factor associated to steroid dependence and extraintestinal manifestations. We recruited a cohort of 110 consecutive patients with UC between October 2006 and July 2008. Among them, 2 patients with incomplete follow-up, 5 with proctocolectomy, and 6 with concomitant autoimmune disease were excluded. Finally, 97 patients were analyzed. ANA titers and staining patterns were determined by indirect immunofluorescence. Test results were interpreted as “positive” if they were above the ones reported for healthy Mexican individuals. In order to identify patients with non-diagnosed systemic lupus erythematosus we also performed anti-double stranded DNA (anti-dsDNA). Gender, age at diagnosis, C-reactive protein (CRP), disease extent, Mayo Score Activity Index, extraintestinal manifestations, and steroid dependence were analyzed in univariate and multivariate models. Numerical variables were analyzed with t-test, and the categorical with χ2 or Fisher's exact test. P value less or equal to 0.05 was considered as statistically significant. Forty-nine female and forty-eight male patients, 41.7 ± 22.2 years age, with 7.6 ± 6.8 years of evolution of the disease were studied. We found that 52 (53.5%) were positive for ANA, and 0 for anti-dsDNA. Prevalence of ANA was higher in steroid-dependent than in non-steroid-dependent patients (77.8% vs 48.1%, P = 0.020, OR = 3.8, CI 95% 1.1 - 12.5), and in those with uveitis (100% vs 51.1%, P = 0.040) or pyoderma gangrenosum (100% vs 51.6%, P = 0.078). No association was observed with gender, age, CRP, disease extent, and Mayo Score Activity Index. The multiple regression analysis model confirmed that only the presence of steroid dependence remained to be associated with ANA (P = 0.033, OR = 3.9, CI 95% 1.4 - 14.9). The prevalence of ANA in Mexican patients with UC is 53.6%. ANA are associated with steroid dependence in UC patients. Further studies are required to determine the role of ANA as serological marker in order to perform early therapeutic interventions with biological agents.