Antinuclear Antibodies In Patients Research Articles

Positive anti-nuclear antibody in patients with polyclonal hypergammaglobulinemia suggests the presence of multiple distinct comorbidities.

Objective Polyclonal hypergammaglobulinemia (PHGG) is a classic problem in internal medicine; however, its conditions and diagnostic procedures have not been well studied. We therefore conducted a retrospective study to characterize the PHGG disease spectrum. Methods We included all patients who underwent serum protein electrophoresis (SPEP) at a hematology tertiary referral center during a five-year period. For these patients, globulin clonality was determined and clinical data were extracted from the records. Results Out of 209 consecutive cases of hypergammaglobulinemia demonstrated by SPEP, 79 cases of PHGG were identified. A total of 46 diagnoses were associated with PHGG. Patients with PHGG were younger (median 71.0 years old (yo) vs. 65 years; P = 0.002) and had lower gamma-globulin levels (median, 26.5 g/L vs 24.8 g/L; P = 0.03) than those with monoclonal hypergammaglobulinemia. Interestingly, out of 79 patients with PHGG, 15 were associated with more than one diagnosis, and a female predominance was observed in this specific subset of patients. PHGG cases with multiple diseases showed higher gamma-globulin levels than those with monoclonal hypergammaglobulinemia, in a disease-dependent manner. Additionally, positive antinuclear antibodies (ANAs) had a discriminative ability with an area under the curve of 0.81 (95% confidence interval, 0.65-0.96) and were highly sensitive to multimorbidity in PHGG (sensitivity, 92.3%). Conclusion These results establish a previously underappreciated unique immunological state of multimorbidity in PHGG and indicate that the gamma-globulin levels and ANAs could serve as markers for the clinical assessment of comorbidities in PHGG.

Clinical significance of serum antinuclear antibodies in patients with autoimmune hepatitis and comorbidity.

Autoimmune hepatitis (AIH) is often complicated with immune diseases, which greatly affected the course and clinical outcome of AIH. We aimed to systematically assess clinical characteristics, prognosis in autoimmune hepatitis accompanied by immune diseases. Clinical records of 358 patients with AIH from Beijing Ditan Hospital in China were retrospectively reviewed. The clinical features of AIH with immune diseases were compared retrospectively, including clinical characteristics, prognosis and outcome. Prevalence of immune diseases in patients with AIH was 26.5%. Connective tissue disease (CTD) was the commonest immune diseases associated with AIH (33/358, 9.2%), and the incidence of primary biliary cholangitis (PBC) and thyroid dysfunction (TD) was low (4.7% and 8.5%, respectively). At diagnosis, AIH-PBC patients had higher IgM and ALP, lower weight, Hgb, ALT and AFP (P < 0.05). Meanwhile, AIH-CTD patients had lower mean platelet volume, serum K and triglyceride (P < 0.05). AIH-TD patients had a lower proportion of ANA positive (P < 0.05). The overall survival time of AIH-TD was significantly shorter than AIH patients (P = 0.0011), but there were no differences in AIH-PBC and AIH-CTD. Furthermore, ANA negative (HR: 0.21, 95%CI 0.13-0.35, P < 0.001) can be a factor to predict the poor prognosis of AIH, and also in AIH-TD patients. About 26.5% of AIH patients had at least one immune disease, and TD coexisted with AIH impaired patients' survival. ANA negative can be used as an independent indicator to predict the poor prognosis of AIH and AIH-TD.

Significance of antinuclear antibodies in patients with COVID-19

Significance of antinuclear antibodies in patients with COVID-19

Utility of a new solid-phase test in combination with indirect immunofluorescence for the screening of antinuclear antibodies in patients with autoimmune rheumatic diseases

article: Utility of a new solid-phase test in combination with indirect immunofluorescence for the screening of antinuclear antibodies in patients with autoimmune rheumatic diseases - La Rivista Italiana della Medicina di Laboratorio 2022 Settembre;18(3):157-61 - Minerva Medica - Journals

Prevalence of Antineutrophil Cytoplasmic Antibodies and Antinuclear Antibodies in Patients with Pulmonary Tuberculosis: A Tertiary Care Center Experience from North India.

Tuberculosis (TB) can have manifestations closely mimicking autoimmune diseases. The prevalence of autoantibodies in TB varies among different populations. To study the prevalence of anti-neutrophilic cytoplasmic antibodies (ANCA) and antinuclear antibodies (ANA) in pulmonary tuberculosis (PTB). This was a cross-sectional, observational study. Subjects with microbiologically confirmed PTB, either via smear or culture positivity on sputum or bronchoalveolar lavage (BAL) fluid, or positive rapid diagnostic tests were included. ANCA against proteinase-3 (PR3), myeloperoxidase (MPO), lactoferrin, and elastase were tested using an enzyme-linked immunosorbent assay (ELISA). ANA was detected using indirect immunofluorescence (IIF). Eighty-nine subjects with a median [interquartile range (IQR)] age of 28 (20-46) years, 67.4% males, were recruited. Eighty-one subjects had microbiological confirmation on sputum examination, and eight required examination of BAL fluid. Sera were drawn from 62 treatment-naïve subjects, the rest (27) were on antitubercular therapy (ATT). Eighty-six (96.6%) subjects tested positive for anti-elastase antibody, seven of which were also positive for anti-PR3. None were positive for anti-MPO and anti-lactoferrin. Six (6.7%) subjects tested positive for ANA. None of the subjects had features of underlying connective tissue disease or vasculitis. PTB patients showed a high prevalence of anti-elastase and a low prevalence of ANA and anti-PR3 antibodies. ANCA positivity should be interpreted with caution in TB endemic areas. The role of anti-elastase antibodies in differentiating TB from ANCA-associated vasculitis (AAV) needs further research.

High prevalence of antinuclear antibodies in patients with chronic hepatitis C virus infection

BackgroundHepatitis C virus (HCV) infection is a serious public health concern due to its high prevalence and mortality rate. In chronic infection, HCV may induce autoimmune responses through the production of autoantibodies, including antinuclear antibodies (ANA).MethodsWe assessed the presence of ANA by indirect immunofluorescence using HEp-2 cells in 89 patients with chronic hepatitis C. We also collected data on epidemiological variables; clinical characteristics; and biochemical, hematological, molecular, and histopathological information from the patients to assess the impact of the presence of ANA in those patients.ResultsThe prevalence of ANA in the patients was 20.2%, which was significantly higher than that found in healthy controls (2%). However, there was no association of this marker with epidemiological, clinical-laboratory, molecular or histopathological characteristics of hepatitis C, although a slightly higher prevalence of ANA was detected in women and in patients infected with subgenotype 1a. In a specific analysis, chronic HCV patients with the “rods and rings” cytoplasmic pattern had higher degrees of hepatic fibrosis than did ANA-negative patients.ConclusionsThe results confirm a greater predisposition to the presence of ANA in patients with HCV, which may be associated with a worse prognosis, especially in the presence of the “rods and rings” cytoplasmic pattern.

The predictive value of antinuclear antibodies in patients with suspected connective tissue disease for the development of connective tissue diseases.

Early confirmation of the diagnosis of connective tissue diseases (CTD) is important, as prolonged disease activity can result in irreversible organ damage. Although antinuclear antibodies (ANAs) have been shown to precede the diagnosis of SLE, this has not been investigated in large cohorts for other CTDs. In this study, we investigated whether the presence of antinuclear autoantibodies in undiagnosed patients suspected of having CTDs is predictive of development of a future CTD. We screened the Electronic Health Records of a cohort of 1030 patients, who were tested for ANAs and their specificity in 2013/2014, to evaluate whether new CTD diagnoses had been recorded by a clinician between the original blood draw date and 2020. We compared the prevalence of ANAs in patients who developed a new CTD diagnosis during follow-up with patients with similar symptoms at baseline who did not receive a subsequent CTD diagnosis and with patients with an established CTD at baseline. Sixteen out of 1030 patients had developed a new CTD in the studied time period. The mean time period between baseline blood draw and subsequent CTD diagnosis of these patients was approximately 2.3 years. Eleven out of 16 (69%) newly diagnosed patients had positive ANA screening tests, compared to 54% of patients with a CTD diagnosis at baseline (p=ns) and 30% of symptomatic undiagnosed patients (p<0.001). This resulted in a positive predictive value (PPV) of 7% and a negative predictive value (NPV) of 98% for the development of a new CTD in undiagnosed symptomatic patients. For specific ANAs associated with the suspected CTD, the PPV was 12%, with a NPV of 98%. Progression to a CTD diagnosis is rare in undiagnosed patients. Undiagnosed patients with symptoms associated with a CTD who progress to a CTD more often have ANAs than patients with similar symptoms who do not progress to a CTD. ANA testing can be used to more stringently select patients who should remain in follow-up.

Diagnostic and Clinical Value of Specific Autoantibodies against Kelch-like 12 Peptide and Nuclear Envelope Proteins in Patients with Primary Biliary Cholangitis.

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease characterized by the presence of antimitochondrial and antinuclear antibodies in patients’ serum. Here, we analyzed the reactivity of autoantibodies against a novel autoantigen, kelch-like 12 (KLHL12) protein, in a cohort of 138 PBC and 90 non-PBC patients. Additionally, we compared the reactivity of KLHL12 with antinuclear envelope antibodies: anti-gp210, anti-p62, and anti-LBR. Commercially available kits and an ‘in-house’ ELISA were used in the studies. Antinuclear envelope antibodies were detected in 65% of PBC patients and the presence of these antibodies was observed more frequently in patients diagnosed with later stages (III/IV) of PBC, according to Ludwig’s classification (p < 0.05) and were found to correlate with a higher concentration of bilirubin. Overall, anti-KLHL12 antibodies were found more frequently in PBC patients than in non-PBC controls (p < 0.001). Anti-KLHL12 antibodies were detected in 36% of the tested PBC cohort, including PBC patients negative for antimitochondrial antibodies. Presence of anti-KLHL12 was also associated with a higher concentration of bilirubin and correlated with fibrosis (p < 0.05). Anti-KLHL12 antibodies were detected in 30% of PBC individuals positive for antinuclear envelope antibodies, while anti-KLHL12 and antinuclear envelope antibodies were found in 17% of all PBC cases. Concluding, our data confirm that antibodies against the KLHL12 protein are highly specific for PBC and when used in combination with other markers, may significantly increase the diagnosis of PBC.

Antinuclear antibodies in patients with endometriosis: A cross-sectional study in 94 patients

Markers of autoimmunity, such as autoantibodies, have been found in patients with endometriosis. These include the antinuclear antibodies (ANA). We aimed to evaluate the prevalence of ANA in a sample of patients with endometriosis and its possible clinical associations. Ninety-four patients with endometriosis and 91 controls were studied for ANA and extractable nuclear antigen (ENA; anti-Ro, anti-La, anti-Sm, and anti-RNP) profiles and anti-dsDNA. Epidemiological, clinical, and staging data in endometriosis were obtained. Patients with autoimmune disorders were excluded. Patients with endometriosis had a 21.2% prevalence of positive ANA vs. 5.4% in controls (P = 0.001). The ENA profile and anti-dsDNA were negative. Patients with positive ANA were more asymptomatic (P = 0.03) and had less dysmenorrhea. No associations with disease duration, patient age, or endometriosis stage were found. We found a high prevalence of positive ANA in patients with endometriosis. The presence of this autoantibody may be linked to a milder clinical expression of the disease.

Prevalence and clinical correlates of antinuclear antibody in patients with gastroparesis.

Autoimmunity may play a role in the pathogenesis of gastroparesis in a subset of patients. Antinuclear antibody (ANA) testing is often used to screen for autoimmune disorders. 1) Determine prevalence of a positive ANA in patients with gastroparesis; 2) Describe characteristics of idiopathic gastroparesis patients with positive ANA. Patients were assessed with gastric emptying scintigraphy (GES), symptom assessment via Patient Assessment of Upper GI Symptoms [PAGI-SYM], and blood tests-ANA, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP). Positive ANA was seen in 148 of 893 (17%) patients with gastroparesis, being similar in idiopathic (16% of 536 patients), T1DM (16% of 162), T2DM (18% of 147), and postfundoplication (19% of 48 patients) gastroparesis. Among 536 patients with idiopathic gastroparesis, ANA titer 1:40-1:80 was seen in 33 (6%) patients, 1:160-1:320 in 36 (7%) patients, and ≥1:640 in 17 (3%) patients. Increasing ANA titer was associated with female gender (p=0.05), Hispanic ethnicity (p=0.02), comorbid rheumatoid arthritis (p=0.02), systemic sclerosis (p=0.004), and elevated ESR (p=0.007). ANA positivity was associated with lower total GCSI (p=0.007) and lower nausea/vomiting subscale (p=0.0005), but not related to gastric emptying. The prevalence of a positive ANA in patients with gastroparesis was high at ~17% and did not differ significantly based on etiology. In idiopathic patients, ANA positivity was associated with rheumatoid arthritis, systemic sclerosis, and elevated ESR. ANA-positive gastroparesis represents a subset who often have other autoimmune symptoms or disorders, but less severe nausea and vomiting.

Thyroid-receptor antibodies, immunoglubulin E and antinuclear antibodies in patients with Graves’ disease and their association with Graves’ orbitopathy and smoking habits

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Prevalence of antinuclear antibody in patients with multiple sclerosis: a case-control study

BackgroundAntinuclear antibody (ANA) is a common test for excluding alternative diagnoses. However, the significance of ANA testing in patients with multiple sclerosis (MS) remains unclear.ObjectivesTo compare the prevalence of positive ANA antibody and its titer between patients with MS (cases) and non-MS patients who attended neurology clinics (control) in Saudi Arabia.MethodsA case-control review of ANA results for all patients who attended a neurology MS clinic. We compared a convenience sample of patients with MS with individuals with general neurology problems and no known autoimmune diseases.ResultsThere were 115 and 103 participants in the MS and control group, respectively. The mean age in the MS and control group was 33.76 ± 8.96 years and 34.95 ± 8.56 years, respectively. In the MS group, 25.22%, 60%, 11.30%, and 3.48% were negative, mildly positive, moderately positive, and strongly positive for ANA, respectively. In the control group, there were 34.95%, 54.37%, and 10.68% were negative, mild positive, and moderate positive, respectively. There were numerically, but not significantly, more positive cases in the MS group (74.78%) than in the control group (65.05%) (p = .117).ConclusionANA testing in routine MS screening for excluding alternative diagnoses should be discouraged unless there is a remarkable history or clinical examination finding. Mild positive ANA is common among patients with MS and does not significantly differ from the general population.

THYROTROPIN-RECEPTOR ANTIBODIES, IMMUNOGLOBULIN E AND ANTINUCLEAR ANTIBODIES IN PATIENTS WITH GRAVES' DISEASE AND GRAVES' ORBITOPATHY.

Thyrotropin-receptor antibodies (TRAb) are biomarkers of Graves' disease (GD) and Graves' orbitopathy (GO). Elevated immunoglobulin E (IgE) and antinuclear antibodies (ANA) were also found in GD patients. We aimed to assess TRAb, IgE and ANA in GD and GO patients and to evaluate the relationship between the immunological markers and smoking. This was a comparative cross-sectional study carried out in a single tertiary care center from June 2018 to January 2020. A total of 103 GD patients (mean age 51.2, 84 females) were divided into three subgroups: moderate-to-severe GO (n=36), mild GO (n=32) and "only GD" subgroup (n=35). Forty healthy controls (HC) (mean age 51.2, 36 females) were also included. TRAb were measured by a thyrotropin-binding inhibitory immunoglobulin (TBII) assay in GD patients; IgE and ANA - by an enzyme-linked immunosorbent assay in all subjects. GD patients had higher IgE-positivity rate (p=0.04) and similar ANA-positivity compared to HC. Moderate-to-severe GO subgroup had the highest TBII (p<0.01), the lowest TBII-negativity rate (p<0.01) and the highest ANA-positivity rate (p=0.03) and was the only subgroup whose IgE-positivity rate was significantly higher than HC (25% vs. 7.5%). Mild GO and "only GD" patients had comparable TBII, TBII-negativity rate, IgE and ANA.Both GO subgroups had significantly higher smoking rate than "only GD" patients. Smoking was positively associated with IgE positivity (φ=0.22, p=0.03), and negatively with TBII negativity rate (φ=-0.24, p=0.02). GD patients exhibit different immunological patterns depending on the presence and severity of GO. Smoking might be just one of the factors responsible for the clinical and immunological variety of GD. Further studies are needed.

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.

Central nervous system-specific antinuclear antibodies in patients with multiple sclerosis

BackgroundNuclear antigen released from central nervous system (CNS) cells undergoing destruction may induce production of antinuclear antibodies (ANA). We characterized the CNS-specific production of ANA in multiple sclerosis (MS). MethodsWe assessed CNS-ANA binding to mouse cerebellar cell nuclei by immunofluorescence assay (IFA) with sera from 104 MS patients (91 relapsing-remitting; 13 secondary progressive), 30 patients with neuromyelitis optica spectrum disorders (NMOSD), and 30 healthy controls (HCs). Conventional ANA (cANA) was detected by IFA using human epithelial type-2 cells. CNS-ANA-positive cANA-negative patients were termed CNS-specific ANA-positive. Western blotting (WB) was performed using mouse cerebellar nuclear fractions. ResultsCNS-specific ANA were more frequent in MS than in NMOSD patients or HCs (13.5% vs 0% for both comparisons, both p < .05) and were associated with HLA-DRB1*15:01 (p = .0174). WB revealed a common 55 kDa band in seven MS patients. Compared with CNS-specific ANA-negative MS patients, those with 55 kDa band-immunoreactive CNS-specific ANA showed a higher frequency of secondary progressive MS (42.9% vs 10.0%, p = .0387) and greater Expanded Disability Status Scale scores (4.50 ± 2.02 vs 2.92 ± 2.27, p = .0506). ConclusionsThe CNS-specific ANA was more frequently detected in MS patients than NMOSD patients or HCs. 55 kDa band-reactive CNS-specific ANA may reflect clinical disease progression in MS.

Thyroid ecostructural implications of antinuclear antibodies in patients with chronic autoimmune thyroiditis and hypovitaminosis D

Thyroid ecostructural implications of antinuclear antibodies in patients with chronic autoimmune thyroiditis and hypovitaminosis D

Antinuclear antibodies in patients with cervical lesions and invasive cervical cancer

BackgroundAntinuclear antibodies (ANA) have been found in several types of cancer although the meaning of its presence is not completely known. AimTo study the prevalence of ANA in patients with cervical intraepithelial lesion and invasive cervical cancer. MethodsA total of 205 women who underwent screening for cervical cancer or treatment at the Erasto Gaertner Cancer Hospital in Curitiba - Brazil, were enrolled in the study. Based on their latest cervical colposcopy-guided biopsy results, they were divided into four groups: CIN-I: 19.4%; CIN-II: 24.0%; CIN-III: 24.0%; and invasive cancer: 32.4%. As control were studied 68 healthy controls. ANA was searched by immunofluorescence in Hep-2 cells evaluating the pattern and titer. ResultsControls had 4/68 (5.8%) of ANA positivity and patients with CIN and invasive cancer had 15.1% (p = 0.001). Patients with CIN-I and CIN-II had the same prevalence of ANA as controls (p = 1.0 and p = 0.11 respectively), but not those with CIN-III (p = 0.03) and invasive cancer (p = 0.05). The most common ANA immunofluorescence pattern was fine speckled pattern (38.7%) and fine dense speckled pattern (38.7%); the mean titer was 1:160. ConclusionANA is more common in invasive cervical lesions than in controls or non invasive lesions. To understand the meaning of this finding more studies are needed.

مستوى عامل الروماتويد والأجسام المضادة النووية في مرضى هيليكوباكتر بيلوري المسببه لآفات المعدة

إن المسببات الدقيقة للأمراض الروماتيزمية غير واضحة، ولكن منذ فترة طويلة اقترح أن التعرض لعوامل بيئية معينة، مثل العدوى البكتيرية، في الأفراد المعرضين وراثيا قد يكون السبب في بدء عمليات المناعة الذاتية. تعتبر هيليكوباكتر بيلوري واحدة من أكثر العوامل المعدية التي تمت دراستها على نطاق واسع والتي تم اقتراحها كعوامل تحفيز للمناعة الذاتية. تم اختيار ثمانين مريضا يعانون من عسر الهضم، لتقييم مستوى عامل الروماتويد والأجسام المضاده النووية في المرضى الذين يعانون من آفات المعدة المرتبطة بالهيلكوباكتر بيلوري. وفقا لنتائج التنظير الداخلي واختبار الأنسجة السريع للهيلكوباكتر بيلوري ، تم تقسيم مرضانا إلى 4 مجموعات 20 مريضًا لديهم نتائج إيجابية بالمنظار ومصابين هيلكوباكتر بيلوري و 20 مريضًا لديهم نتائج إيجابية بالمنظار وغير مصابيت هيلكوباكتر بيلوري و 20 مريضًا لديهم نتائج سلبية بالمنظار و ومصابين هيلكوباكتر بيلوري و 20 مريضًا يعانون من نتائج سلبية بالمنظار و غير ومصابين هيلكوباكتر بيلوري لجميع مجموعة المرضى، تم إجراء التقييم السريري الكامل، والتحقيقات المخبرية الروتينية، والتنظير العلوي مع واختبار الأنسجة السريع للهيلكوباكتر بيلوري، و مستوى عامل الروماتويد والاجسام المضاده النووية كانت مستويات مستوى عامل الروماتويد والأجسام المضاده النووية بين المرضى المصابين بالبكتيريا أعلى بشكل ملحوظ بالمقارنة مع المجموعات غير المصابة، علاوة على ذلك، كانت مستويات مستوى عامل الروماتويد والاجسام المضاده النووية أعلى في المرضى المصابين بـ البكتيريا مع آفات المعدة مثل القرحة المعوية والتهاب المعدة أو التهاب الإثنى عشر. ينصح بشدة دراسة إضافية لتقييم تأثير القضاء على هيليكوباكتر بيلوري

Preliminary Study on Antinuclear Antibodies in Patients With Chronic Dilatory Eustachian Tube Dysfunction.

There are some known reasons for chronic dilatory Eustachian tube dysfunction (chronic D-ETD, also known as chronic obstructive tube dysfunction), for example infections, hyperplastic adenoids, or tumors. In many cases though, none of these reasons apply. The question arises whether there might be an autoimmune pathogenesis in patients with idiopathic chronic D-ETD. The study includes 31 consecutive patients with chronic D-ETD and 92 consecutive blood donors (BD, comparative cohort). The production of antinuclear antibodies (ANA), as an indicator for autoimmune pathologies, was measured in the serum of patients and BD. ANA titers were significantly higher in patients with chronic D-ETD, compared with BD (p = 0.0027). The results weighted clearly toward higher ANA titers in younger patients. A comparison of ANA titers in patients and BD aged less than 40 years showed a significant difference (p = 0.0062), whereas it was not significant between patients and BD aged ≥ 40 years (p = 0.19). The significant results of elevated ANA titers in chronic D-ETD make an autoimmune pathogenesis highly probable, at least in some of the patients concerned. Further research with higher numbers of patients is needed to confirm the hypothesis of an autoimmune chronic D-ETD. A better understanding of etiology and pathogenesis of chronic D-ETD might open up new and perhaps even causal therapeutic strategies.

High prevalence of antinuclear antibodies in patients following venous thromboembolism.

Growing evidence suggests that activation of blood coagulation exerts protective functions during inflammation. However, it has been hypothesized that dysregulated immunothrombosis may lead to venous thromboembolism (VTE). Antinuclear antibodies (ANAs) are considered to promote the thrombotic tendency but there have been no reports on the association between ANAs and VTE. The objective of this study was to investigate if the presence of ANAs is associated with VTE. We enrolled 283 consecutive patients, aged 18-66 years old, following a VTE episode, and 165 age-matched healthy controls. Patients with documented autoimmune diseases (n = 56, 19.79%), including antiphospholipid syndrome (n = 48, 16.9%), were excluded. Antinuclear antibodies were determined based on immunofluorescence. The specific immunofluorescence patterns observed at serum dilution equal to or greater than 1:100 were considered as positive ANAs. The final analysis included 227 patients (aged 41.07 ±11.4, 98 males, 129 females) following provoked (n = 111) or unprovoked (n = 116) VTE. Ninety-four (42.2%) patients had positive ANAs, including 32 (33.3%) with ANAs titer ≥1:320, whereas as few as 14 (8.4%) controls had positive ANAs (p < 0.007). ANA-positive patients were more commonly diagnosed with unprovoked (n = 55; 57.4%) than provoked VTE (n = 39; 40.6%) (p = 0.03). A similar observation was made for ANAs titer ≥1: 320 (26 patients with unprovoked vs 20 patients with provoked VTE, p = 0.04). The presence of ANAs in the patient group did not correlate with age, sex, time since the VTE event, type of anticoagulation and its quality, inflammatory markers and D-dimer. The prevalence of positive ANAs was 5 times higher among VTE patients than in controls. Antinuclear antibodies occur commonly in VTE and might be involved in the pathogenesis of unprovoked VTE.