ANA Test Research Articles

The sensitivity and specificity testes for diagnosis of rheumatoid arthritis/ Jordan

Background: Prognosis, treatment, and even early detection of rheumatoid arthritis may all be effectively tracked. Serological tests may be used to validate clinically suspected preliminary diagnoses of rheumatic disorders, track the effectiveness of treatment, and predict the prognosis of autoimmune diseases. for CRP, anti-citrullinated peptide antibodies, anti-streptolysine O, acute phase proteins, rheumatoid factor, and CRP. Aims of the study: focused on diagnostic designs that tested the sensitivity and specificity of diagnoses. such as ANA, ACCP, ASO, and CRP Laboratory Tests of Rheumatoid arthritis. Methods: ELIZA tests were used to refer 79 individuals to the Immunology department, specifically the rheumatic ward. Statistical test: Statically analysis: was carried out using ANOVA. Results: Most patients with RA tested positive for anti-CCP. 86% of RA patients have positive test findings. According to ASO, there may be an increase in RF without an increase in ASO in some circumstances. This is because there may be additional health issues contributing to the auto immune disease. Other results may also indicate an increase in ASO and CRP without an increase in RF. Conclusions: We came to the conclusion that ACCP antibodies and CRP are the most sensitive and specific tests for the diagnosis of RA.

Clinical Profile and Outcomes of Patients With Systemic Lupus Erythematosus.

Background Systemic lupus erythematosus (SLE) is a complex autoimmune disorder characterized by relapsing-remitting immune system activation, affecting multiple organ systems. Despite significant advances in understanding SLE's pathogenesis, there remains a need for comprehensive clinical profiling at the time of diagnosis to improve early detection and management. This study addresses this gap by providing a detailed analysis of the clinical presentation, disease activity, and patient outcomes using the Systemic Lupus International Collaborating Clinics (SLICC) criteria and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) index. Methodology This cross-sectional observational study included 80 patients diagnosed with SLEusing the 2012 SLICC criteria. Patients were recruited from the Rheumatology department and other wards of Byramjee JeejeebhoyGovernment Medical Collegeand Sassoon General Hospital, Pune, India. All participants provided informed consent and institutional ethical approval was obtained. Data were collected through detailed clinical history, physical examinations, and standard tests such aschest X-rays, CBC, RFT, LFT, urine microscopy, creatine phosphokinase, ANA, AntiDsDNA, complement consumption, and Coombs' tests, with 2D echocardiography performed as needed. Follow-ups every three months over 1.5 years assessed disease activity using SLEDAI criteria. Patients aged 12 and above who met the SLICC criteria were included and those with other connective tissue disorders were excluded. Associations between clinical symptoms and organ involvement were analyzed using thechi-square testwith a p-value of <0.05 considered significant. Results The study evaluated 80 patients with SLE, revealing a predominantly female cohort (80%) with a mean age of 29.4 years and a standard deviation of 8.3 years, skewed towards younger age groups. Clinical manifestations were diverse; the most common symptoms were (83.75%), oral ulcers (98.75%), and alopecia (95%). Anemia (66.25%) was the most prevalent abnormality, followed by albuminuria and renal abnormalities. Organ involvement was highest in the renal system (50%) and mucocutaneous features, with lower incidences in cardiac, gastrointestinal, and vascular systems. Gender-specific analyses indicated significant differences in SLE nephritis (p=0.048) and autoimmune hemolytic anemia (p=0.046). Autoantibody profiles showed high positivity for ANA (98.8%) and DsDNA (61.3%). Clinical outcomes demonstrated that 68.8% of patients achieved remission and 16.3% experienced organ damage. The SLEDAI scores significantly improved over time, with substantial reductions from baseline to nine months (p<0.001). Conclusion In conclusion, this study provides a detailed examination of SLE, revealing that it predominantly affects young adults and is characterized by diverse manifestations including mucocutaneous symptoms, significant renal involvement, and notable autoantibody profiles. The high prevalence of anti-nucleosome and anti-dsDNA antibodies underscores their diagnostic and prognostic value. Clinically, the findings highlight the necessity for early detection and targeted management of SLE, particularly in addressing renal and mucocutaneous symptoms. Future research should focus on longitudinal studies to track disease progression, explore genetic and environmental influences, and investigate regional variations to enhance treatment strategies and patient outcomes.

Relationship of TSH and FT3 Levels to The Incidence of Hashimoto's Thyroiditis in Autoimmune Patients

Hashimoto's thyroiditis is portrayed by the presence of thyroid autoantibodies. Pathogenetic systems, a few cytokine networks have been recognized to be engaged with thyroid cells in a progression of proinflammatory impacts, like the statement of provocative parts, and a progression of imperfections in administrative Lymphocytes that control the deficiency of resistance to thyroid autoantigens, subsequently assuming an immediate part in the autoimmune cycle causing a few diligent side effects. The point of this review was to assess the connection between 36 autoimmune patients matured 14 to 52 years with responsive ANA test results. Then, Thyroid-Animate Hormone (TSH) and free Triiodothyronine (fT3) levels were analyzed utilizing the Enzyme-linked immunosorbent assay (ELISA) technique. The consequences of the review showed that the quantity of ladies was more prominent than men, 32 individuals (88.9%) and 10 individuals matured between 20-25 years. The typical TSH level was 9.65uIU/mL and the free T3 level was 1.64pg/ml. The consequences of the Spearman connection test among TSH and free T3 levels got a worth of p = 0.029 (p&lt;0.05), implying that the connection between TSH levels and the free T3 test had an adequate relationship of - 0.364 (0.260-0.500), however was negative and not in a similar heading, so that when the levels TSH expands, fT3 levels will diminish. All in all, in autoimmune sufferers essential hypothyroidism happens, when the thyroid organ creates low Free T3, causing the deficiency of negative criticism restraint on the front pituitary, bringing about expanded creation of the TSH hormone which causes Hashimoto's thyroiditis.

Clinical characteristics and risk factors for lupus flares in sub-Saharan Africa-retrospective cross-sectional study.

Systemic lupus erythematosus (SLE) is an autoimmune disease with a variable course with unpredictable flares. Identifying predictors of these flares is essential for monitoring and timely hospital care. To characterize the prevalence of flares within the first five years of SLE diagnosis and determine the clinical and immunological characteristics associated with flare development among patients attending the Rheumatology Clinic at Tikur Anbesa Specialized Hospital (TASH) and Lancet General Hospital. A multicenter, cross-sectional study was conducted from May 2023 to November 2023 at TASH and Lancet General Hospital. The data was collected from electronic medical records and analyzed using SPSS version 26. Logistic regressions were used to determine factors associated with lupus flare. Most patients with SLE were female (95.4%). The most common clinical presentations were musculoskeletal (71.8%), cutaneous (55%), and constitutional (22%). Almost half (44.3%) of the patients had comorbidity illness. Positive ANA test was found in 96.5% of the patients, whereas only 55% had positive anti-dsDNA test. The prevalence of SLE flare in the first five years of SLE diagnosis was 38.9%, and most flares occurred within the first year of diagnosis. Patients with the following characteristics were more likely to have flare-ups: younger age at diagnosis (less than 25years old), initial presentation with vasculitis, renal flare, and being on low-dose prednisolone. The most common clinical presentations were musculoskeletal, dermatologic, and constitutional manifestations. Age < 25years at diagnosis, initial clinical presentation with renal manifestation, and being on low-dose prednisolone were predictors of SLE flare. Key Points • This study found a significant gender disparity, with 95% female. • Nearly 39% of patients experienced an SLE flare within the first five years of diagnosis. • Over three-quarters (77%) of flares occurred within the first year of diagnosis. • Age less than 25years, initial presentation with vasculitis, renal involvement, and being on low-dose prednisolone were identified as predictors of flares.

The relationship between serum transglutaminase-2 levels and the severity of chronic spontaneous urticaria

Chronic spontaneous urticaria (CSU) is an immunological disease that is depicted by high prevalence and eminent burden for patients and society that is attributable to the arbitrary nature of symptoms and inconsistent tools for assessment of activity and severity. Transglutaminase-2 (TG2) is a posttranslational enzyme that is pervasively expressed in many cells and tissue types including mast cells. It has various biological functions, and its role in allergic disorders has been highlighted and delineated through several postulated mechanisms. This case–control study aimed at determining the relationship between serum levels TG2 and severity of CSU. To the best of our knowledge, this is the first study in Egypt to determine the relationship between serum TG2 and severity of CSU. We enrolled 60 adult patients with confirmed diagnosis of CSU. According to urticaria activity score (UAS), patients were categorized into three groups [20 with mild disease; UAS = 0, 20 with moderate disease; UAS = 1–3, 20 with severe disease; UAS = 4–6]. Another 20 healthy individuals (age and gender matched) served as a control group. All patients were subjected to detailed medical history, clinical examination, complete blood count with differential, serum total IgE, CRP, ESR, TSH, ANA, liver and renal function tests. Serum level of TG2 was done by quantitative ELISA for all enrolled patients and controls. Serum TG2 is significantly higher in patients group compared to control group (P value < 0.001). Serum TG2 levels were significantly higher in patients with severe disease compared to patients with moderate or mild disease. This is illustrated by the significant positive correlation between serum TG2 and UAS (r 0.814 and P value 0.000). Moreover, serum TG2 accurately classified CSU patients into mild, moderate and severe subgroups: as regards differentiation between mild and moderate cases (sensitivity 70%, specificity 80%, PPV 77.8, NPV 72.7) and as for the differentiation between moderate and severe cases (sensitivity 95%, specificity 90%, PPV 90.5, NPV 94.7). Serum TG2 may have a pivotal role as a marker of severity in patients with CSU.

P154 Male lupus characteristics from multi-ethnic cohort

Abstract Background/Aims Systemic lupus erythematous (SLE) is a chronic autoimmune (AI) disease of unknown etiology. It predominantly presents in women and only 1 in 10 of sufferers are men. We sought to examine the clinical pattern in male lupus patients in a tertiary multi-ethnic lupus centre in East London, UK. Methods Male lupus patients were identified through review of a pre-existing lupus patients database and clinic lists at Barts Trust. All patients’ electronic notes were reviewed prior to a telephone interview. All the participants fulfilled the ACR 1997 criteria for SLE. Descriptive data analysis was performed for all identified patients. Results Fifty-one patients were identified. Sample demographics showed that male lupus was more prevalent among Afro-Caribbeans (37%,n=19), followed by Asians (33%,n=17) and Caucasians (29%,n=15). The median age was 40.5 (IQR:32.5-52.7) years, with median age at SLE diagnosis 28 years (IQR:23-45).Family history of an AI condition was seen in 25%, whilst 14% had a family history specifically of SLE. Possible significant stressor prior to diagnosis reported in 45% (n = 23) patients. Serological evidence of previous infection with EBV, VZV or parvovirus was found in 76%. Although all patients were below the state pension age of 66, more than half were unemployed. The majority of males had multiorgan involvement including renal (67%,n=34), cutaneous (55%,n=28), hematological (45%,n=23), musculoskeletal (31%,n=16), cardiac (27%,n=14), pulmonary (20%,n=10), and neurologic (14%,n=7). Renal biopsy was done in 33/34 renal cases and the showed proliferative class-III/IV in 65%. Hypertension was a significant comorbidity in 39%, 47% had a concomitant AI condition. Juvenile-onset SLE was diagnosed in 6% of the patients with median age at disease onset 10 years (IQR:14-16,100% Caucasians). These males all had kidney nephropathy class-IV/V. Regarding serology, 94% were positive for antinuclear antibody, 40% speckled, 31% homogenous, and 8% for nucleolar and mixed pattern. Two patients ANA test was not recorded but they had confirmed renal/cutaneous biopsy findings.Three-quarters were positive for anti-double stranded DNA. Ro and La antigens were detected in 35% and 8%, while anti-Sm and anti-RNP antibodies were detected in 37% and 43%, respectively. Antiphospholipid antibodies were identified in less than a third, of which 40% presented with thrombotic events. Triple antiphospholipid antibodies was detected in 53%, 20% had LA, 15% had aCL, and 7% had either anti-B2GP1 or aCL/anti-B2GP. Conclusion Our dataset demonstrates a higher prevalence in Afro-Caribbean and Asians and a young age of onset (median 28 years) with presentation about 10 years earlier than most other reports. The majority were unemployed and reported significant life-stressors. Over three-quarters of patients had evidence of prior infection.Most of the lupus males had multiorgan involvement and over two-thirds had renal involvement, proliferative class-III/IV. There was a high prevalence of dsDNA, ENA (anti-Ro) and APL. Disclosure H. Aldeyarbi: None. S. George: None. G. Marchan: None. R. Rajakariar: None. A. Cove-Smith: None. A. Pakozdi: None. M. Cunningham: None. M. Lewis: None. B. Turner: None. D. Pyne: None.

CHALLENGING DIAGNOSIS AND MANAGEMENT OF INFECTIOUS SCLERITIS COMPLICATED WITH CORNEAL PERFORATION CAUSED BY MULTI DRUG RESISTANT Proteus mirabilis

Introduction : Scleritis is a destructive inflammatory disease of sclera and may involve the cornea that associated with an underlying systemic disease and smaller minority are due to infections. The two conditions closely mimic each other, and diagnostic delay can lead to a poor outcome&#x0D; Case Illustration : A 72 year old male presented with severe pain, redness, swelling, and dimness of vision in his left eye. On slitlamp examination, a superonasal scleral nodule with overlying conjunctival defect and corneal ulcer was found. Both ANA test and RA factor were negative. Microbiological investigations of the lessions revealed MDR Proteus mirabilis. His left eye rapidly deteriorated leading to an impending perforation of the sclera and corneal perforation despite intensive antimicrobial therapy, then patient underwent a tibial periosteal graft on his left eye. Although the visual prognosis was poor, structural integrity of the eye was achieved&#x0D; Discussion : Infection is a rare cause of scleritis. Among the organism reported till date, Proteus mirabilis, a gram negative, rod shaped bacterium is the rarest to found. The inciting factors are mostly surgical. There was history of cataract surgery on left eye in this case&#x0D; Conclusion : infectious scleritis is often initially diagnosed as autoimmune, and cause diagnostic delay, the aggressive nature of the associated microbes further complicates the situation. Appropriate diagnosis generally includes lession scrapings with thorough culturing and antibiotic sensitivity testing. Both adequate medical and surgical methods are needed to save the globe from loss

AN UNILATERAL SCLEROMALACIA PERFORANS IN YOUNG PATIENT MANAGED BY MYOCONJUNCTIVAL ENUCLEATION AND DERMIS FAT GRAFT

Introduction : Scleromalacia perforans is a disease that might compromise vision and globe integrity. The possible associations of systemic disease are autoimmune diseases such as rheumatoid arthritis, lupus, and Wegener's granulomatosis. Determining the underlying etiology in such cases also possess a great challenge to treat disease, especially in this case.&#x0D; Case Illustration : A 19-year-old female with a progressed protrusion of the left eye since she was 1 year old. Six years ago, she had redness, worsen protrusion, photophobia, tearing, and pain, but resolved without treatment. Her cousin had the same condition but refused to continue the examination. Visual acuityof the left eye was no light perception with 4x4 mm of corneal leukoma, and 360 degrees of anterior scleral ectasia covered with conjunctival neovascularization. USG showed posterior vitreous detachment and 28,9 mm axial length. Systemic examination found ANA test and HLA B27 were normal, positive hypermobility joint, and Rheumatologists ruled out the possibility of autoimmune disease. Myoconjuctival enucleation was performed with a dermis fat graft for cosmesis, and pathological examination showed nonspecific chronic inflammation.&#x0D; Discussion : A childhood-onset scleromalacia perforans with positive family history and hypermobility joints might be a sign of connective tissue disorder. Possible autoimmune diseases were ruled out by a rheumatologist. The genetic examinations may be necessary to establish the diagnosis.&#x0D; Conclusion : Scleromalacia perforans is rare yet it is strongly believed to have an association with systemic disease. Collaboration between ophthalmologists, rheumatologists, and geneticist is essential to manage this kind of case.

Respiratory arrest following severe muscle weakness as initial presentation of Sjögren’s syndrome: diagnostic and therapeutic strategies: a case report

Background: SjÖgren’s syndrome refers to an autoimmune disorder defined by chronic inflammation as a consequence of the exocrine gland’s lymphocytic infiltration. Patients may present with heterogeneous clinical symptoms involving impairment in the lungs, kidneys, and nervous system. The most common renal involvement is tubulointerstitial nephritis (TIN) responsible for 20% of renal tubular acidosis. We report a case of respiratory failure resulting from severe hypokalemia in a patient with SjÖgren syndrome. Case presentation: A 46-year-old female who experienced progressive quadriplegia leading to respiratory distress caused by severe hypokalemia. Laboratory findings showed: sodium 128 mmol/L, potassium 1.1 mmol/L, Cloride 93 mmol/L, Calcium 7.3 mg/dL (corrected 7.5 mg/dL), albumin 3.3 g/dL, Magnesium 1.8 mg/dL with amylase 244 U/L, lipase 4168 U/L, The ANA test increased slightly and Ro-52, PM-Scl100 showed strong positive results, finally the patient was diagnosed with SjÖgren's syndrome with renal tubular acidosis (RTA). She was later diagnosed with renal tubular acidosis secondary to SjÖgren’s syndrome and treated using methylprednisolone, potassium, and alkali administration. Later, her potassium levels reached normal, muscle weakness improved, and she was extubated. Conclusion: This case emphasizes the concept of an uncommon form of SjÖgren's syndrome in the form of severe refractory hypokalemia due to renal tubular acidosis accompanied by acute pancreatitis disguised in patients without SICCA complaints. Renal tubular acidosis is a rare case, but SjÖgren's syndrome is a cause that must be considered in all patients who present with paralysis due to refractory hypokalemia so that there is no misinterpretation and management.

High Titer ANA at Pediatric ITP Presentation Associated with Progression to Systemic Lupus Erythematosus

Introduction: Immune thrombocytopenia (ITP) is a feature of systemic lupus erythematosus (SLE) in 5-20% of cases. ITP may present at the time of SLE presentation or may precede SLE diagnosis by up to nearly a decade. Even in the absence of an SLE diagnosis, ITP patients may have a positive ANA in ~20% of cases. Some studies suggest that a positive ANA in ITP may herald chronic and more refractory disease, while other studies have not demonstrated a link between ANA+ ITP and progression to SLE. The natural history of ANA+ pediatric ITP patients remains unclear. With the concept that hydroxychloroquine may modulate progression to systemic autoimmunity, European hematologists report using hydroxychloroquine in ANA+ pediatric ITP patients with titers as low as 1:160. However, whether ANA+ ITP patients represent a distinct cohort clinically and should receive different therapies is not well established. The goals of this study were to evaluate the significance and degree of a positive ANA titer at presentation in a cohort of pediatric ITP patients. Methods: Data from a retrospective cohort of 711 ITP patients treated at Texas Children's Hospital from 2012-2022 were reviewed. Patients were defined as SLE if diagnosed as such by rheumatology. To focus on the prognostic value of an ANA upfront, the cohort was refined to include only ITP patients with ANA testing within the newly diagnosed period (0-3 months). Individuals who received IVIG prior to ANA testing were coded as having a missing ANA result given the possibility of false positive results. Being diagnosed concurrently with SLE and ITP was defined as diagnoses within 1 month of each other. Fisher's exact tests were used to compare nonparametric data with a P &amp;lt;0.05 defined as statistically significant. P values were corrected for multiple testing. Results: One hundred sixty-one ITP patients were included for analysis. The cohort was an average of 11.9 years-of-age with a slight female predominance (58.4%). Most of the population self-identified as White and non-Hispanic (84.7%, 45.5%). Nearly 80% had primary ITP and 66.7% were ultimately diagnosed with chronic ITP (cITP). The mean follow-up time for the cohort was 2.2 years (with a range from 0 to 12 years). Forty-seven of 161 (29.2%) individuals had a high titer ANA ³1:1280 at ITP presentation. (Figure 1) There was a statistically significant difference in ANA titer and presence of secondary ITP (P&amp;lt;0.001). Sixty-eight percent (n=23) of secondary ITP patients had a high titer (≥1:1280) ANA versus 20% (n=24) of the primary ITP patients. There was no difference between ANA titer and development of cITP vs. non-cITP. Of this cohort, 20 patients had an ANA tested at ITP presentation and were diagnosed with SLE by rheumatology. Most of these patients had an ANA titer ≥1:1280 (84.2%). The remaining 3 patients had titers of 1:320. Of this cohort, 9 patients had SLE and ITP diagnosed concurrently and 2 had SLE preceding ITP diagnosis by an average of 3.8 years. All 11 patients had an ANA ≥1:1280. Of the 9 who were not diagnosed with SLE at ITP presentation, 6 (66.6%) had an ANA ≥1:1280 and 3 had a titer of 1:320. The lead time to being diagnosed with SLE after presenting with ITP was 1.76 years. Discussion and Conclusions: In this cohort, high titer ANAs in newly diagnosed ITP patients were linked to development of secondary ITP and SLE. Lower titer ANAs were less common, even in those who went on to develop SLE. These findings suggest that specifically high titer ANA results may herald SLE development in pediatric ITP patients. To allow the onset of SLE to be identified earlier, individuals with a high titer ANA at ITP presentation may warrant closer follow-up to monitor for progression to systemic autoimmune disease. This subset of ITP patients could benefit from earlier institution of SLE-directed therapy, such as hydroxychloroquine. Further analysis is underway, including expansion of this analysis to multiple sites within the Pediatric ITP Consortium of North America, as well as surveying pediatric ITP treaters on their practice regarding ANA testing and management in ITP patients.

In vivo ameliorative effects of vitamin E against hydralazine-induced lupus

ObjectiveIn this study, we investigated the in vivo ameliorative effects of vitamin E in a hydralazine-induced lupus model, which closely resembles SLE in humans. We aim to shed light on...

Subacute Cutaneous Lupus Erythematous

Subacute Cutaneous Erythematous (SCLE) is an Auto-Immune skin disorder that cause skin sores and rashes when your immune system attacks itself. In this case report describe 39 years old female patient with SCLE. It is characterized by either ring-shaped red scaly border and also scaly red bumps in sun exposed areas associated with itching, pain and burning sensation. In this case, the patient has a multiple red colour lesions initially on the upper back region then spread to B/L UL, abdomen, chest, face and LL which is aggravating to sunlight. The patient is having a history of skin burns like lesions, tuberculomas and SJS. The diagnosis of SCLE was revealed by clinical presentation, Skin biopsy result and laboratory finding i.e. ANA Test was found to be highly positive and confirms that it is an autoimmune disease. The patient was treated with corticosteroid drug, DMARDs along with antihistaminic drugs and supportive therapy like nutritional supplements and skin lotion for external application, which led to significant improvement in the lesion formation and other symptoms. The case report highlights the careful monitoring and appropriate treatment of SCLE.

Hematological and Musculoskeletal Manifestations of Systemic Lupus Erythematosus in A Patient with Chronic Hepatitis C Virus Infection

Systemic lupus erythematosus (SLE) is an autoimmune disease that can present with various clinical manifes- tations, and early diagnosis and treatment are crucial to prevent irreversible organ damage. Here, we report a case of a 35-year-old female with chronic hepatitis C virus (HCV) infection who presented with hematolog- ical and musculoskeletal symptoms, ultimately leading to a diagnosis of SLE. The patient’s workup included positive ANA and dsDNA tests and a CT scan revealing an oval-shaped lytic lesion in the medullary cavity of the right iliac bone.

DETECTION OF CYCLIC CITRULLINATED PEPTIDE ANTIBODIES IN PATIENTS WITH AUTOIMMUNE DISEASE AND BACTERIAL INFECTION

Background:Autoantibodies, commonly known as CCP antibodies or anti-CCP antibodies, are a kind of antibody. The immune system produces proteins called antibodies and autoantibodies. Your immune system can defend you against disease by battling external agents like viruses and bacteria. By mistakenly targeting the body's healthy cells, autoantibodies can lead to illness. Methods: Between the first of September 2022 and the first of November 2022, 50 venous blood samples (5 ml) from rheumatoid arthritis patients in Baghdad were obtained. With a history of autoimmune illnesses,the patients ranged in age from 19 to 79 and included both sexes—11 men and 39 women. Up to usage, serum samples were kept at -20°C. Private laboratories in Baghdad were contacted for blood samples. RF-LATEX - Linear Chemicals kit was used to identify rheumatoid factor - RF isotypes (IgG, IgM), while Snibe Company China's completely automated system was used to detect anti-CCP antibodies and ANA. Results: There were fifty individuals with rheumatoid arthritis. Of them, 11 (22%) are male and 39 (78%) are female.Additionally, some of these patients have chronic tonsillitis, middle ear infections, and recurrent gingivitis. All of these patients also have high blood pressure despite their young age, and some of them have a family history of the disease in one of their parents, suggesting that genetic factors may have contributed to the infection. As a result, their RA is categorized as severe. The highest incidence of RA disease in females was in the age group (49 – 40) years with a percentage of 11(28.20%). In men, the highest incidence of the disease was in the two age groups (40-49) years and (60-69) years with a percentage of 3(27.27%) for the two age groups. 7 (14%) male patients had positive RF test results, 4 (8%) had positive ANA test within ranges ranging from 45.1 IU/ml to 101.8 IU/ml, and 7(11%) of the patients were positive for the anti-CCP antibody test. While it was found that 30 (69%) of the female patients had positive RF test results, 25 (50%) of the female patients had a positive ANA test within ranges of 45.1 to 101.8 IU/ml as in males, and 36 (72%) of the female were positive for an anti-CCP antibody test. Conclusion: Although not everyone with a positive anti-CCP Ab will have RA, this test is a little more specific than the RF for RA. Anti-CCP antibody levels that are greater are more suggestive of RA

Clinical diagnoses associated with a positive antinuclear antibody test in patients with and without autoimmune disease

BackgroundAntinuclear antibodies (ANA) are antibodies present in several autoimmune disorders. However, a large proportion of the general population (20%) also have a positive test; very few of these individuals will develop an autoimmune disease, and the clinical impact of a positive ANA in them is not known. Thus, we test the hypothesis that ANA + test reflects a state of immune dysregulation that alters risk for some clinical disorders in individuals without an autoimmune disease.MethodsWe performed high throughput association analyses in a case–control study using real world data from the de-identified electronic health record (EHR) system from Vanderbilt University Medical Center.The study population included individuals with an ANA titer ≥ 1:80 at any time (ANA +) and those with negative results (ANA-). The cohort was stratified into sub-cohorts of individuals with and without an autoimmune disease. A phenome-wide association study (PheWAS) adjusted by sex, year of birth, race, and length of follow-up was performed in the study cohort and in the sub-cohorts. As secondary analyses, only clinical diagnoses after ANA testing were included in the analyses.ResultsThe cohort included 70,043 individuals: 49,546 without and 20,497 with an autoimmune disease, 26,579 were ANA + and 43,464 ANA-. In the study cohort and the sub-cohort with autoimmune disease, ANA + was associated (P ≤ 5 × 10–5) with 88 and 136 clinical diagnoses respectively, including lupus (OR ≥ 5.4, P ≤ 7.8 × 10–202) and other autoimmune diseases and complications. In the sub-cohort without autoimmune diseases, ANA + was associated with increased risk of Raynaud’s syndrome (OR ≥ 2.1) and alveolar/perialveolar-related pneumopathies (OR ≥ 1.4) and decreased risk of hepatitis C, tobacco use disorders, mood disorders, convulsions, fever of unknown origin, and substance abuse disorders (OR ≤ 0.8). Analyses including only diagnoses after ANA testing yielded similar results.ConclusionA positive ANA test, in addition to known associations with autoimmune diseases, Raynaud’s phenomenon, and idiopathic fibrosing alveolitis related disorders, is associated with decreased prevalence of several non-autoimmune diseases.

Interstitial lung abnormality in COPD is associated with higher prevalence of antinuclear antibody

ABSTRACT Object To investigate whether the prevalence of positive ANA was increased in COPD with interstitial lung abnormality (ILA). Methods Patients with COPD from 1 September 2019 to 31 August were consecutive enrolled in this cross-sectional study. The characteristics, PFTs, visual assessment of ILA and emphysema on chest CT, and tests for ANA and CRP were recorded for analysis. Results In the study period, 100 patients with COPD were enrolled, with 90 (90.0%) males, aging 69.4 ± 8.3 years. ILA was present in 42% (n = 42) of the patients, with subpleural non-fibrotic ILA being the most common pattern. In patients with ILA, the prevalence of positive ANA was higher (45.2%) as compared to those without ILA (13.3%); between whom the difference in DLCO was also significant. In patients with positive ANA, the scores of ILA were higher, while FEV1, DLCO, DLCO % predicted, FVC, total lung capacity (TLC), and TLC % predicted were significantly lower, as compared to those with negative ANA. Conclusion The presence of ILA in patients with COPD was associated with a higher prevalence of positive ANA. Patients with positive ANA tended to have lower FEV1, DLCO and lung volume.

The Frequency of Immune Thrombocytopenic Purpura in Collagen Vascular Disorders

Background: Many rheumatologic conditions are associated with thrombocytopenia due to antibody-mediated platelet destruction. Knowing the rate of ITP patients who develop vascular collagen diseases and the developed type can help predict future treatments and even take preventive measures. Objectives: This study aimed to know the frequency of immune thrombocytopenic purpura (ITP) in collagen vascular disorders. Methods: The present retrospective cross-sectional study was conducted in 2020 on the health records of 447 eligible patients. First, the patient’s details, such as age, gender, marital status, age at diagnosis, time from the diagnosis of ITP to the development of lupus, and the patients’ ANA and anti-dsDNA test results, were extracted from their records and entered into the preparation checklist. Finally, the data were entered into SPSS-23 and analyzed at a statistically significant level of 0.05. Results: The mean interval between the initial diagnosis of ITP and vascular collagen disease diagnosis was 2.1 ± 0.9 years. The records of 336 patients with systemic lupus erythematosus (SLE) were also assessed, of whom 15 (4.5%) had first developed ITP and then lupus. Hence, of the 447 patients included in the study, 17 (3.8%) with a history of ITP then developed lupus. Conclusions: Comparing the present findings with the results of other studies shows that Iranian patients with ITP develop vascular collagen disease at a lower rate.

P-505 Role of intramuscular immunoglobulin in improving the live birth rate in ANA positive women with recurrent pregnancy loss

Abstract Study question In ANA positive women with Recurrent Pregnancy Loss, could addition of intramuscular Immunoglobulin along with appropriate adjuvant therapy improve the live birth rate ? Summary answer In ANA positive RPL patients, addition of Intramuscular immunoglobulin along with glucocorticoids and low dose aspirin improves the live birth rate What is known already RPL is a frustrating condition which affects 1-3% of women trying to conceive. Presence of ANA is associated with autoimmunity, which affects trophoblast development and vascular remodeling process thereby resulting in pregnancy loss. Latest ESHRE guidelines also suggest ANA testing for explanatory purpose. Aspirin has anti-platelet and anti-inflammatory effects, and glucocorticoids exhibit a beneficial effect in autoimmune diseases. Therefore, they are considered conventional adjuvant therapies in ANA-positive women with RPL. Addition of Immunoglobulin for RPL patients benefits by the down-regulation of primary antibody production, the modulation of complement activation and Suppresses Nk cell cytotoxicity Study design, size, duration 72 ANA positive patients with Unexplained RPL were enrolled in the study. Anatomical, metabolic ,genetic and other immunological causes for RPL were excluded. Out of 72 patients 36 patients were allotted to the treatment group, who received intramuscular immunoglobulins along with Low dose aspirin and glucocorticoids, remaining 36 patients were allotted to the control group, who received only Aspirin and glucocorticoids. Duration of study extended from jan2021 till Dec 2022 Participants/materials, setting, methods 72 patients with unexplained RPL underwent ANA screening using Indirect Immunofluorescence technique in the pre conception period. Patients with a titre ≥1:80 were considered to be significant and enrolled in the study. Patients were allotted to the Treatment and Control group based on personal choice of the patient after informed consent. Live birth rate was the primary outcome analyzed. Main results and the role of chance There were no significant differences in socio-demographic characteristics between group. Patient characteristics – Age, BMI, Ovarian reserve, sperm factor and number of previous Pregnancy losses were matched.Treatment group who received Intramuscular immunoglobulin once in 3 weeks right from the time of positive pregnancy test till 28 weeks along with low dose aspirin and glucocorticoids had a live birth rate of (23/36 ) 63.8 % whereas Control group who received only Low dose Aspirin (75 mg) and Glucocorticoids had a live birth rate of 41.6 % (15/36). Other obstetric outcomes which were analysed were Pre Eclampsia and GDM which were comparable between both the groups.Preterm labour was marginally higher in the control group. Limitations, reasons for caution Because of limited sample size results need to be interpreted with caution. Screening for ANA antibodies in patients were done only preconceptionally, and we were not aware about their ANA titres in pregnancy. This study involves only patients who conceived with IVF treatment and doesn't include spontaneous natural conception Wider implications of the findings ANA screening in RPL cases is suggested to prognosticate the outcome. Addition of Immunoglobulins significantly increases the live birth rate in these cases. Role of Immunoglobulin in patients with altered cellular immunity has to be further studied which is likely to benefit other cases of unexplained RPL. Trial registration number not applicable

Antinuclear antibodies in children: indirect immunofluorescence patterns, antigen targets and associated diagnoses

Antinuclear antibodies tests are of a paramount importance in the diagnosis, classification, prognostic evaluation and management of autoimmune diseases in children. The present study aimed to describe the immuno-clinical profile of antinuclear antibodies tests in a pediatric population in order to guide the clinical practice of biologists and clinicians. Our study enrolled 268 children. Antinuclear antibodies screening was performed using the indirect immunofluorescence assay on HEp-2 cells. Identification of target antigens was conducted using separately or at one timepoint the following techniques: enzyme-linked immunosorbent assay, Immunodot and Chemiluminescence. The average age of patients was 9.6 ± 4.3 years, with a female predominance (sex-ratio = 1.9). Antinuclear antibodies screening was positive in 40.67% of cases. The most frequently observed antinuclear antibodies patterns were speckled (52.3%), homogeneous (13.8%) and mixed homogeneous-speckled (13.8%). Autoantibodies were detected in 4 patients (2.51%) for whom ANA testing using the indirect immunofluorescence assay was negative. Positive antinuclear antibodies specificities were detected in connective tissue diseases (44.03%; n = 48), organ-specific autoimmune diseases (10.09%; n = 11), and in non-autoimmune conditions (inflammatory diseases, infections, hematological diseases, vasculitis and Wilson’s disease) (32.08%; n = 35). Our study revealed a high rate of positive antinuclear antibodies tests in the pediatric population, mainly related to autoimmune diseases (54.12%) besides non-autoimmune conditions (32.08%). Therefore, screening and interpretation of antinuclear antibodies testing in children require the consideration of clinical data and a close collaboration between clinicians and biologists.

Comprehensive management of pregnant woman with Sjögren’s syndrome

HIGHLIGHTS 1. Sjögren’s syndrome is a chronic autoimmune disease that attacks the exocrine glands, especially lacrimal and salivary glands. 2. Comprehensive management of pregnant women with Sjögren’s syndrome was described.3. Clinical and laboratory examination, risk assessment and also preconception counseling before planning pregnancy are needed by women with Sjögren’s syndrome. ABSTRACT Objective: To illustrate the comprehensive management of pregnant women with Sjögren syndrome. Case Report: A 24 years old women came to Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, due to Sjögren syndrome in 35/36 weeks of gestasional age for routine examination. She was first diagnosed with Sjögren syndrome in February 2018 because she complained of dry eyes and hair fall out. This was her first pregnancy. Laboratory result showed positive ANA test. The patient had hypertension with controlled blood preasure and dry eyes. The patient was diagnosed with primigravida 35-36 weeks of pregnancy, single live intrauterine, head presentation, IUGR, screening preeclampsia was positive, and there was complication with Sjögren’s syndrome. The patient was treated by multidisciplinary team consisting of obstetricians, internists, ophthalmologists and neonatologists. Conclusion: Sjögren’s syndrome is a chronic autoimmune disease that attacks the exocrine glands, especially lacrimal and salivary glands. The exact cause of Sjögren's syndrome is still not known. Women with Sjögren’s syndrome should have clinical and laboratory examination, risk assessment and also preconception counseling before planning pregnancy because Sjögren syndrome was a rare case during pregnancy. Close monitoring and proper management was imperative to detect the early complication.