Antinuclear Antibodies Negative Patients Research Articles

A multicenter longitudinal study of the prevalence and mortality rate of systemic lupus erythematosus patients in Oman: Oman Lupus Study.

This study is a longitudinal multicenter study which aims to find the prevalence, the demographic data, survival and mortality rates of patients with systemic lupus erythematosus (SLE) in Oman. All Omani patients, pediatrics and adults diagnosed with SLE, who fulfill either the 1997 American College of Rheumatology or Systemic Lupus International Collaborating Clinics classifications criteria for SLE were included from January 2006 till February 2020. In total 1160 patients were included in this cohort. Data analysis showed that patient's ages ranged from 2-82years with female predominance and female-to-male ratio of 7:1 (87.7% female,12.3% male). The mean prevalence of SLE among different age groups was 38.8 (range 5-63 per 100000 inhabitants). The mortality rate was found to be 5%. Male patients had significantly higher mortality rate than females (7.6% vs 5.4%, P value = .04). Sepsis was the commonest cause of mortality (34%). The coexistence of systemic sclerosis correlates significantly with death (P = .002). Survival analysis in our data showed 5, 10, 20, 40-year survival rates of 100%, 100%, 99% and 90% respectively for antinuclear antibody (ANA) positive patients and lower survival rate for ANA negative patients with 5,10, 20, 40-year survival rates of 100, 99%, 99% and 75%, respectively. This study showed that the mean prevalence of SLE in Oman to be 38.8 (range 5-63) per 100000 inhabitants. The 40-year survival rate among patients with positive ANA was found to be 90%, while patients with negative ANA had worse survival outcomes.

Characterization of anti-nuclear antibodies in patients with oral submucous fibrosis and its clinicopathologic implications - An immunofluorescence study.

Background:Oral submucous fibrosis (OSF), widespread in the Indian subcontinent, is a chronic debilitating disease of the oral cavity having a high potential for malignancy. The etiology of OSF is debatable. However, recently, autoimmunity had been suggested to play a significant role in its etiology, yet unproven. Hence, this study was conducted to explore the presence of antinuclear antibodies (ANAs) in the serum of OSF patients which is one of the serum markers of autoimmune diseases and its possible clinicopathologic associations.Materials and Methods:A total of 105 blood samples were collected from patients with OSF (n = 45), age- and sex-matched healthy controls with (n = 30) and without (n = 30) areca nut chewing habit. Serum positivity of ANA was determined by immunofluorescence and correlated with the oral habits and severity of the disease measured by maximum mouth opening (MMO) and site of involvement.Results:Significantly higher incidence of ANA (35.6%) was found in 45 OSF patients than in the healthy group (P = 0.001). Prevalence of ANA positivity was found higher in females (n = 11; 68%) than males (P < 0.001). A significantly lower MMO (P = 0.00) was found in ANA positive patients (17 ± 6.21 mm) in contrast to MMO in ANA-negative patients (28.74 ± 6.58 mm). The mean duration of habit and frequency of habit between ANA positive and negative patients was not significant. A significantly more number of sites of involvement was seen in ANA positive cases (P = 0.004). Out of 16 ANA positive OSF cases, 10 cases showed + 2 and 6 cases showed + 3 fluorescence intensity. Speckled (n = 8), homogeneous (n = 5) and nucleolar pattern (n = 3) were the fluorescence patterns observed.Conclusion:The presence of autoantibodies such as ANA, female predilection, alteration of humoral and cellular immunity justifies OSF as an autoimmune disease. This study provides broader prospective to adopt therapies that selectively target autoimmune pathways.

Clinical and pathological characteristics of ANA/anti-dsDNA positive patients with antineutrophil cytoplasmic autoantibody-associated vasculitis

Antineutrophil cytoplasmic autoantibodies (ANCA) associated vasculitis (AAV) consists of a group of systemic autoimmune diseases. The roles of serum anti-nuclear antibodies (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies in AAV patients remain unknown. This study investigated the prevalence of serum ANAs and anti-dsDNA antibodies in AAV patients and characterized the clinical and pathological features of these patients. A total of 218 AAV patients were enrolled. Clinical and pathological data of patients were analyzed retrospectively. Of the 218 AAV patients, 109 (50.0%) were positive for ANA, 45 (20.6%) were positive for anti-dsDNA, and 43 (19.7%) were positive for both. The AAV patients with ANA had severer kidney damage and more chronic renal histopathological changes compared to those who were negative for ANA. Specifically, patients positive for ANA had more hypertension, higher levels of urea nitrogen and serum creatinine, lower estimated glomerular filtration rate (eGFR), more end-stage renal disease (ESRD), severer proteinuria, glomerular sclerosis, tubular interstitial fibrosis and tubular atrophy, and were more likely to receive renal biopsies compared to ANA negative patients. The study found ANA and anti-dsDNA in AVV patients were not rare, ANA-positive AAV patients had severer kidney damage and more chronic renal histopathological changes compared to ANA-negative AAV patients. Renal biopsy is strongly recommended for differential diagnosis in such cases.

P316 Hepatobiliary manifestations measured by vibration-controlled transient elastography in inflammatory bowel disease: A prospective hospital-based cohort study

Abstract Background Intestinal mucosal injury is supposed to cause liver disease and inflammatory bowel disease (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) is a typical chronic injury of intestinal mucosa. Therefore, we investigated the hepatobiliary manifestation with liver ultrasonography (LUS) and vibration-controlled transient elastography (VCTE) in IBD. Methods IBD patients newly diagnosed in Kosin University Gospel Hospital were enrolled consecutively. Gross hepatobiliary abnormality was evaluated with LUS and simultaneous liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were assessed to evaluate hepatic injury and steatosis with VCTE. Laboratory tests including hepatic biochemistries, anti-nuclear antibody (ANA), and faecal calprotectin level (FC) were taken. Results Eighty-two (37 patients of CD and 45 UC) patients were enrolled. Gallbladder abnormality was noted in 39 patients (47.5%) including stone in 7, sludge in 11, polyp in 10, wall thickening in 9 and collapsed in 2. CAP &amp;gt;233 dB/m was in 33 patients (40.2%) and LSM &amp;gt;5.5 kPa in 10 (12.2%). Nineteen patients (23.2%) were diagnosed fatty liver. FC was 382 ± 785 (mean ± SD). CAP &amp;gt;233 dB/m was significantly associated with lower FC (209.6 vs. 352.1, p = 0.038). The correlation coefficient was −0.316 between CAP and FC (p = 0.006). LSM &amp;gt;5.5 kPa tended to be lower FC but was not statistically significant (199.8 vs. 306.2, p = 0.283). ANA was positive in 14 patients (17.1%). In ANA positive patients, FC was significantly higher than ANA negative patients (609.5 vs. 319.4, p = 0.015). Conclusion In this prospective analysis, the major hepatobiliary manifestations in IBD patients were gallbladder abnormality and fatty liver and there could be an association between low hepatic fat amount and intestinal disease activity.

Antinuclear Antibody Positivity in Chronic Hepatitis C Patients: Effect on Histopathology and Impact on Early Response to Combined Antiviral Therapy

Background and study aim : The prevalence of antinuclear antibody (ANA) has been documented in patients with hepatitis C virus (HCV) infection. Hepatitis C virus infection plays an important role in the pathogenesis of immunological derangement, but the mechanism remains unclear. The aim of this study is to detect the significance of ANA positivity and its impact on histopathology and early virological response (EVR) to combined antiviral therapy in chronic HCV patients. . Patients and Methods:Two hundred Egyptian chronic HCV naive patients were enrolled in this study. Antinuclear antibody (ANA) was detected by ELISA and it was considered positive with a titer > 1 : 14 by indirect immunofluorescence. Complete laboratory investigations and histological examination were done as a pretreatment work up for all patients. Patients were followed up during treatment and EVR was assessed in ANA positive and negative patients. Results: There was a statistically significant difference between ANA positive and negative patients regarding viral load and histopathological criteria and no significant difference was detected regarding other demographic and laboratory criteria. EVR was close in ANA positive and ANA negative patients (77 for the former Vs. 80 for the later with P = 0.33). No autoimmune manifestations were detected during treatment among positive cases. Except for ALT & AST levels no statistically significant differences were detected between ANA positive and negative cases regarding haematological data, thyroid dysfunction. BMI, ALT levels, viral load and fibrosis stages were independent predictors of EVR. Conclusion: ANA postivity in chronic HCV patients was associated with advanced fibrosis but didn't affect treatment response.

Diagnostic utility of unidentified precipitin lines (UPLs) in immune precipitation assays

Unidentified precipitin lines (UPLs) are lines in immune precipitin assays which do not characterise with known extractable nuclear antigen (ENA) antibodies. Currently, the clinical significance of UPLs is uncertain.The aim of this study was to determine the clinical and laboratory correlates of UPLs detected over a 3 year period in a regional immunopathology laboratory.A total of 144 patients with UPLs on ENA testing were retrospectively analysed.ENA by counterimmunoelectrophoresis (CIE) was performed on 11,869 patient samples with further characterisation being performed for 1437 positive results. Ten percent of the positive ENAs demonstrated UPLs. The majority of patients with UPLs were female (71%) with an average age of 60 years. Precipitin lines for both continuously growing myeloid cell line K562 and rabbit thymus extract (RTE) were more frequent (47%), compared to K562 only (41%) or RTE only (12%). The most common antinuclear antibody (ANA) patterns associated with UPLs were speckled (29%), homogenous (16%), mixed patterns (14%), with 30% negative ANA and 5% showing cytoplasmic patterns (Golgi, GWB, mitochondrial). Both ANA positive and ANA negative patients with UPLs were generally associated with connective tissue and autoimmune disease with the majority demonstrating a positive association of UPLs with Ro52 and/or Ro60/SSA detected by Euroimmun line immunoassay. UPLs frequently seen with a negative ANA were also identified in renal disease, pulmonary fibrosis/bronchiectasis and malignancy/lymphoma.UPLs have uncertain diagnostic utility at this stage and further work needs to be done to clarify this question. UPLs were found in systemic and organ specific autoimmune disease, renal, pulmonary and neoplastic disorders. UPLs can occur in both ANA positive and ANA negative sera. The nature of the precipitating antigen in UPLs is still obscure.

AB0650 Autoantibody Profile in Systemic Sclerosis Associated Pulmonary Hypertension

BackgroundPulmonary hypertension (PH) is a severe complication of systemic sclerosis (SSc), affecting around 10% of patients. A recent meta-analysis showed an overall 3-year survival of 52%1. The impact of autoantibody...

FRI0481 Microvascular Modifications in Very Early Systemic Sclerosis Patients

BackgroundGreat interest is devoted today to patients with very early diagnosis of systemic sclerosis (VEDOSS), characterized by the presence of Raynaud phenomenon (RP), puffy fingers, Antinuclear antibodies (ANA), plus the...

SAT0107 Antinuclear Antibody Positivity in RA Patients and Its Impact on Persistency of TNF Inhibitors

BackgroundRecently, it was reported that the antinuclear antibody (ANA) before starting anti-TNF treatment or development of ANA might be related with clinical response of TNF inhibitors or side effect of...

Serum autoantibodies positivity prevalence in patients with chronic HCV and impact on pegylated interferon and ribavirin treatment response

Prevalence of serum autoantibodies in chronic hepatitis C (HCV) patients is higher than that in the general population. Interferon may induce autoimmune manifestations in patients treated with peg-interferon and ribavirin. Effect of autoantibody seropositivity and treatment response are limited and controversial. To detect the prevalence of serum autoantibodies in patients with chronic HCV and impact on histopathology and treatment response. Retrospective study including 3673 Egyptian chronic HCV naïve patients enrolled in the Egyptian national programme for HCV treatment with pegylated interferon and ribavirin in the years 2007-2010. Antinuclear antibody (ANA) was determined by ELISA considered positive with a titre ≥ 1:40 by indirect immunofluorescence. ANA-positive patients pre treatment workup including serum aminotransferases, thyroid profile and liver biopsy, follow-up during treatment and sustained virological response (SVR) were assessed compared to ANA-negative patients. Serum ANA was positive in 1.6% of the studied patients. There were no statistically significant differences concerning the demographic, biochemical and histopathological data in ANA positive and negative patients. SVR was comparable between ANA-positive and ANA-negative patients (67.8% and 61.3% respectively). Follow-up treatment; ANA-positive patients' did not experience statistically significant haematological complications, flare-up of serum transaminases, thyroid dysfunction. No systemic autoimmune disorders developed during follow-up. ANA positivity is not a factor in chronic HCV disease progression and does not affect the treatment response. Pegylated interferon and ribavirin therapy is safe and effective in autoantibodies-positive chronic HCV patients with no need for further follow-up or worry during the treatment in absence of systemic autoimmune disorders.

Is there a predisposition for the development of autoimmune diseases in patients with fibromyalgia? Retrospective analysis with long term follow-up

The objectives of the study were to evaluate the prevalence of antinuclear antibodies (ANA) in patients with fibromyalgia (FM) and the probability of the development of clinically overt connective tissue diseases. Four hundred and fifty FM patients were compared to 129 healthy matched blood donors. ANA testing was performed by immunofluorescence on rat tissue sections; in case of highly positive results, ANA were specified further by ELISA and immunodiffusion. All ANA positive FM patients were invited for a control examination. The ANA negative patients received a questionnaire, which was designed to identify those patients with possible connective tissue diseases (CTD). There was no significant difference in the frequency of ANA or thyroid antibodies between patients and controls (11.6% vs. 7%). Two patients had developed SLE: one was already ANA/anti-dsDNA positive at time of first diagnosis of FM; in the other, specific antibodies and SLE-related symptoms developed after 4.5 years. The probability for FM patients to develop CTD (SLE) within one year is 0.0027%, which is comparable to the incidence of SLE in the general population (0.005%). The risk of CTD is not increased in FM. The detection of ANA does not predict the development of CTD. However, in individual cases, FM may be an early sign of an autoimmune disease.

Prevalence and Significance of Autoantibodies in Patients With Non-Alcoholic Steatohepatitis

The aim of this study is to evaluate the prevalence and the clinical and histologic correlates of autoantibodies in patients with nonalcoholic steatohepatitis (NASH). Antinuclear antibodies (ANA) and anti-smooth muscle antibodies (ASMA) have been identified in patients with NASH. The significance of autoantibodies in NASH is uncertain. Clinical data from patients with a histologic diagnosis of NASH at a university hospital in Chicago, Illinois between January 1999 and April 2003 were reviewed retrospectively. Seventy-four patients who were tested for autoantibodies and had no history of alcohol abuse or a systemic autoimmune disease were included. Demographic information and laboratory data were collected. Autoantibody titers > or = 1:40 were considered positive. A single pathologist reviewed all liver biopsies and scored features of NASH and identified characteristics of autoimmune hepatitis. Thirty-four percent of patients with NASH had positive ANA titers and 6% were ASMA positive. Demographic and laboratory parameters did not differ by ANA status, except that women were more frequently ANA positive then men (P = 0.01). The severity of steatosis, inflammation, and fibrosis on liver biopsy were similar in the ANA positive and negative groups. Only 15% of ANA positive patients with NASH had a plasma cell infiltrate on liver biopsy and there was no difference in the frequency of histologic features of autoimmune hepatitis between ANA positive and negative patients. Antinuclear antibodies are common in patients with NASH and most frequently represent a nonspecific antibody response that is not associated with the pattern or severity of injury on liver biopsy.

Anti-nuclear antibody, anti-DNA, and aCL in Graves' disease patients treated with propyluracil or methimazole.

One hundred and forty patients with Graves' disease [32 new patients, 54 treated with propylthiouracil (PTU) for a mean of 27.2 months and 54 treated with methimazole (MMI) for a mean of 48.6 months] were tested for anti-thyroid microsomal antibody (AMA), anti-thyroglobulin antibody (ATA), thyroid binding inhibitory immunoglobulin (TBII), and the non organ specific autoantibodies [i.e., anti-nuclear antibody (ANA), anti-double stranded DNA antibody (anti-dsDNA Ab), anti-cardiolipin antibody (aCL Ab) and anti-beta2-glycoprotein I antibody (IgG beta2GPI)]. Treatment with MMI or PTU produced a significant difference in IgG aCL Ab production but not in ANA, dsDNA Ab, IgM aCL or IgG beta2GPI. For those treated with MMI but not those treated with PTU, ANA and anti-dsDNA Ab were positively correlated. IgG and IgM aCL Ab were positively correlated overall and for those on MMI but not PTU treatment. No significant difference was found for any of the four non organ specific antibodies in AMA positive or negative patients but there was a significant difference in IgG aCL positivity rates for ATA positive and negative patients. On the other hand, ANA negative patients were significantly more likely to have higher TBII values. These results suggest that the appearance of the non organ specific autoantibodies is probably largely a coincidental effect of polyclonal activation - except, perhaps, for IgG aCL, which may be related to treatment.

Identification of retroviral conserved pol sequences in serum of mixed connective tissue disease and systemic sclerosis patients

Human endogenous retroviruses (HERVs) expression has been suspected as a factor participating in the development of autoimmune diseases. Employing the dot blot hybridisation, we observed that 90.9% of mixed connective tissue disease (MCTD) ( n = 22) patients exhibited the presence of human immunodeficiency virus type 1 (HIV-1) conserved pol sequence in DNA isolated from serum. The same investigation conducted in the group of systemic sclerosis (SSc) ( n = 79) patients identified a conserved retroviral pol sequence in 34.6% of antinuclear antibodies (ANA) positive ( n = 52) and 40.7% of ANA negative ( n = 27) patients. However, 100% of anti-U1-ribonucleoprotein (RNP) positive SSc ( n = 9) patients exhibited the presence of HIV-1 conserved pol sequence. Our findings suggest that the presence of retroviral sequence in serum of MCTD and SSc patients may correlate with development of autoimmune response directed against U1-70 kDa polypeptide antigen.

Necrotizing Lymphadenitis in Systemic Lupus Erythematosus Kikuchiʼs Disease or a Kikuchiʼs-Like Disease?

Kikuchi's disease or histiocytic necrotizing lymphadenitis is a recognized cause of benign lymphadenopathy, although the current clinical literature also supports a link with systemic lupus erythematosus (SLE). Eight patients represent all the cases of Kikuchi's disease admitted to our hospital from 1990 to 1997. They were all young women of median age of 31 years (range 22-43 years). All patients showed cervical lymphadenopathy, and in two cases splenomegaly was present. In one patient, the diagnosis of lupus preceded the onset of Kikuchi's disease by 5 months. In 4 other patients, antinuclear antibodies (ANA) were positive at titers ranging between 1:80 and 1:2560 and were associated with leukopenia ranging from 1190 to 2800 white blood cells/mm3 when the diagnosis of Kikuchi's disease was made. Among these, 3 patients developed SLE after periods ranging from 6 to 25 months. The other ANA positive patient and the 2 remaining ANA negative patients did not develop any autoimmune disease after 2-A years of follow-up.The differential diagnosis between Kikuchi's disease and lupus lymphadenitis cannot always be clarified histologically. We recommend that patients with necrotizing lymphadenitis, leukopenia, and ANA be closely followed. This should ensure an early diagnosis of development of an autoimmune disorder that will require treatment, rather than always considering these patients to be affected by a benign self-limited disorder like Kikuchi's disease.

Studies on associations between human leukocyte antigen (HLA) class II alleles and antiphospholipid antibodies in Danish and Czech women with recurrent miscarriages.

Autoantibody production is commonly associated with particular HLA class II phenotypes. The aim of the present study was to investigate whether the presence of antiphospholipid (APL) antibodies and other autoantibodies in women with unexplained recurrent miscarriage was associated with particular human leukocyte antigen (HLA)-DR or -DQ alleles or linked epitopes which have previously been reported as being associated with the recurrent miscarriage syndrome or the presence of APL. In a total of 123 Danish and Czech women with recurrent miscarriage, serum was investigated for six different APL antibodies including anticardiolipin (ACL) antibody. Antinuclear antibodies (ANA), anti-zona pellucida antibodies and anti-sperm antibodies were also investigated. The women were HLA-DR and -DQ typed by DNA-based methods. The frequency of HLA-DR phenotypes did not differ significantly between APL antibody positive recurrent miscarriage patients and APL antibody negative recurrent miscarriage patients or healthy controls. Among ACL antibody positive recurrent miscarriage patients, significantly more were positive for the HLA-DR3 phenotype and negative for the HLA-DR2 phenotypes compared with healthy controls (P < 0.05). Among ANA positive recurrent miscarriage women, 55% carried the HLA-DR3 phenotype compared with 28% of ANA negative patients (P < 0.05) and 21% of healthy controls (P < 0.002). In conclusion, among recurrent miscarriage women, the HLA-DR3 phenotypes seem to predispose to formation of ACL antibodies and ANA. The association between APL antibodies and particular HLA alleles and HLA-linked epitopes reported in studies of patients with lupus erythematosus (e.g. HLA-DR7 and -DR4) could not be confirmed in patients with recurrent miscarriage.

Antinuclear Antibodies in Children with Chronic Nonspecific Complaints

Children who are chronically complaining nonspecific symptoms such as headache, fatigue, abdominal pain, and low grade fever are commonly seen in daily pediatric outpatient clinics. Some of them are unable to go to school and are diagnosed as school refusal by physicians or educational staff. On the other hand, there are children who do not fulfill any criteria of collagen diseases and whose anti-nuclear antibodies (ANA) are found to be positive. Some of these children have chronic nonspecific complaints. We prospectively studied the prevalence of ANA in children who visited a pediatric outpatient clinic because of chronic nonspecific complaints. Surprisingly, 74 out of 140 symptomatic children (52.4%) were positive for ANA, while only 5 out of 82 healthy control children (6.1%) were positive (p < 0.0001). 39 of 74 ANA positive patients (52.1%) have low ANA titers <1:80, nevertheless 36 patients (47.9%) have high ANA titers > 1:160. ANA fluorescent patterns were homogeneous and speckled in 75.3%, speckled in 17.6% and others in 6.8%. ANA positive patients tended to have general fatigue and low grade fever, while gastrointestinal problems such as abdominal pain and diarrhea and orthostatic dysregulation symptoms were commonly seen in ANA negative patients. Children who were unable to go to school more than 1 day a week were seen significantly more in ANA positive patients than in negative patients. Autoantibody analysis using Western immunoblot revealed that 26 out of 63 ANA positive sera (41.3%) had antibodies to the 62 kD protein which had not been previously noticed. These data suggest that autoimmune mechanism may play a role in childhood chronic nonspecific symptoms. We therefore propose a new disease entity of the autoimmune fatigue syndrome in children. When chronically complaining children visit a pediatric out-patient clinic, immunological approaches should be considered before they are discriminated as school refusal or having psychogenic disorders.

Predictors of Renal Involvement in Patients with Recent Onset Systemic Lupus Erythematosus

We have examined the demographic, clinical, and laboratory predictors of the concomitant or subsequent occurrence of lupus nephritis among a cohort of patients with disease manifestations < 1 year diagnosed as systemic lupus erythematosus (SLE) either at entry (baseline) into the cohort or during the subsequent 5 years. Patients studied were from a larger cohort with either early defined or undifferentiated connective tissue diseases; of the possible 74 patients, data were adequate in 58, 44 with SLE at entry and 14 at followup. Demographic, clinical, and laboratory data were examined first by univariate and then by multivariate analyses for their ability to predict lupus nephritis.Thirty of the 54 patients developed lupus nephritis with proteinuria as its most common manifestation. In 25 of the 30, nephritis occurred within the first 2 years of disease. Among those with a renal biopsy, the most common finding was World Health Organization class IV. By univariate analysis, the following variables were found more frequently among those patients who developed lupus nephritis versus those who did not: younger age, hypertension, anti-double-stranded deoxyribonucleic acid and baseline diagnosis of SLE. In the multivariate analysis, only SLE at baseline and hypertension were identified as predictors of nephritis, whereas the presence of nonvasculitic skin rashes were negatively associated.Lupus nephritis is an early event in the course of SLE. Antinuclear antibody negative patients and those with incomplete SLE are less likely to develop lupus nephritis. Concomitant hypertension is associated with an increased risk of nephritis.

The lupus anticoagulant. A disease marker in antinuclear antibody negative lupus that is cross-reactive with autoantibodies to double-stranded DNA.

The lupus anticoagulant (LA) was demonstrated in 37% of 52 consecutive systemic lupus erythematosus (SLE) patients and patients with lupus-like syndromes, who were referred to our unit. The LA was found to be associated with a biologic false-positive VDRL (P less than 0.005), and the apparently paradoxical association of LA with vascular thromboses was confirmed (P less than 0.05). The presence of LA and a biologic false-positive VDRL defined a group of 7 antinuclear antibody negative patients with characteristic features of recurrent thromboses, spontaneous abortions, neurologic involvement, and renal disease. Further studies on 6 selected sera demonstrated LA in all 6 IgM fractions and in 3 of 6 IgG fractions. Inhibition of LA was shown in 6 of 9 Ig fractions after absorption with double-stranded DNA (dsDNA). Anticardiolipin antibody was shown by immunodiffusion in 3 LA positive IgG fractions from VDRL negative sera. Cardiolipin micelles partially inhibited anti-dsDNA binding of 4 IgG fractions, 3 of which were LA negative. In this report we discuss the overlapping specificities due to cross-reactivity between LA, anticardiolipin, and anti-dsDNA antibodies in human SLE, and we suggest that LA be considered equivalent to the biologic false-positive VDRL as a criterion for the diagnosis of SLE.

Prevalence of antinuclear antibodies in patients with habitual abortion and in normal and toxemic pregnancies.

The prevalence of antinuclear antibodies (ANA) was investigated in the sera from patients with habitual abortion (HA) and in normal (NP) and toxemic pregnancies (TP). ANAs were more prevalent in patients with HA (30%) as compared with TP (15%) and the control group (6.6%). Only one patient, from the HA group, fulfilled four criteria for systemic lupus erythematosus (SLE). Most other patients with positive ANAs had some of the criteria for SLE, but none of the ANA negative patients had any of them. These studies suggest that there is a high prevalence of ANA in our group of women with HA and their identification may help to identify those patients who may eventually develop SLE which has been reported to be preceded in many women by repeated spontaneous abortions. In addition, immunological factors, at least in some cases, could play a role in the pathogenesis of HA.