Serum Antinuclear Antibody Titers Research Articles

Prevalence of antinuclear antibodies and rheumatoid factor titers in dogs with arthritis secondary to leishmaniosis (Leishmania infantum).

Dogs with infectious arthritis may occasionally exhibit positive serum antinuclear antibody (ANA) and rheumatoid factor (RF) titers; however, relevant data are sparse for arthritis secondary to canine leishmaniosis (CanL) caused by Leishmania infantum. We determined the prevalence of positive serum ANA and RF titers in dogs with arthritis secondary to CanL. Blood samples from adult, client-owned dogs with purulent arthritis secondary to CanL, without any comorbidities, were collected for diagnostic purposes. Serum ANA titers were measured by immunoperoxidase test and RF titers by the Rose-Waaler latex test. Twelve of 23 dogs enrolled prospectively in our study had clinical arthritis, and 11 of 23 had subclinical arthritis. Based on LeishVet clinical staging, 7 dogs had clinical stage II disease, 11 had clinical stage III disease, and 5 had stage IV. None of the 23 dogs was seropositive for ANA; 3 of 23 were positive for RF. ANA and/or RF seropositivity, in dogs with CanL-associated arthritis, appears to be weak, if present at all. Based on our results, positive serum ANA and RF titers should not be expected in dogs with arthritis secondary to CanL.

Salivary anti-nuclear antibody (ANA) mirrors serum ANA in systemic lupus erythematosus

ObjectivesTo assay salivary anti-nuclear antibody (ANA) and its isotypes in patients with systemic lupus erythematosus (SLE) and to investigate relevant clinical associations.MethodsSaliva samples were collected from SLE patients and assayed for salivary ANA using immunofluorescence (IF). Isotypes of salivary ANA, including IgG-ANA, IgA-ANA, and IgM-ANA, were quantified using enzyme-linked immunosorbent assay. The correlations between clinical parameters and levels of salivary ANA and isotypes were evaluated.ResultsSalivary ANA IF intensities were significantly higher in SLE patients than in healthy controls, irrespective of SLE patient disease activity, and strongly correlated with serum ANA titers. Salivary ANA was detected in 67.14% of SLE patients and 10.00% of healthy controls (p < 0.001). Among ANA-positive samples, 80.85% exhibited a nuclear ANA pattern, and 42.55% exhibited a cytoplasmic ANA pattern. Salivary IgG-ANA, IgA-ANA, and IgM-ANA levels, as assayed by ELISA, were significantly increased in both active and less active SLE patients compared with healthy controls, and levels of each isotype were significantly correlated with serum ANA titer. Salivary IgM-ANA levels correlated with the physician global assessment (PGA), SLE disease activity index (SLEDAI), and negatively with serum C3 and C4. Salivary IgG-ANA also correlated with erythrocyte sedimentation rate (ESR), SLEDAI, and negatively with serum C3.ConclusionSalivary ANA levels correlate with serum ANA titer, and salivary IgM-ANA and IgG-ANA correlate variably with PGA, SLEDAI, ESR and complement levels. These findings underscore the potential of using salivary ANA and ANA isotypes as surrogates for serum ANA, particularly for future point-of-care applications since saliva is easier to obtain than blood.

Factors associated with the antinuclear antibody (ANA) titer of systemic autoimmune rheumatic diseases in ANA-positive patients after treatment: a retrospective study.

Antinuclear antibodies (ANAs) are a serological hallmark of systemic autoimmune rheumatic diseases (SARDs); however, few studies have investigated their post-treatment levels. The mechanism by which ANA titers are upregulated in SARDs remains unclear. We assessed factors associated with the ANA titer after treatment. In this retrospective study, we analyzed the clinical database of Zhongshan Hospital, Medical College of Xiamen. Demographic data and baseline and 12-month post-treatment ANA titers were collected. Bivariate and multivariate analyses were performed to determine the factors associated with the ANA titer. This study identified 31,923 patients who underwent ANA assay for SARDs screening, and a total of 1043 patients were included in the study. Approximately 16% of the patients showed a decrease in the serological ANA titer. Younger patients (< 20) were 3 × more likely to experience such a decrease (P = 0.005) compared to older patients (≥ 60years). Having a baseline ANA titer > 1:10,000 was associated with an increase likelihood of a decrease in the serological ANA titer compared with baseline ANA titer 1:10,000, 1:3200 and 1:1000 (P < 0.001). We found that a decrease in the serum ANA titer at 12months after treatment for SARDs is associated with age and ANA baseline titers.

Epidemiological survey of antinuclear antibodies in healthy population and analysis of clinical characteristics of positive population.

BackgroundIn China, the incidence of autoimmune diseases is gradually increasing. To decrease the misdiagnosis rate of autoimmune diseases, we conducted an epidemiological investigation about the presence of antinuclear antibody (ANA) in healthy populations and analyzed the clinical characteristics of healthy population with both high titer of ANA and positive anti‐SSA and AMA‐M2.MethodsSerum ANA titers were detected by indirect immunofluorescence (IIF), and other 15 types of ANA‐specific antibodies were detected by line immunoassays.ResultsIn 25 110 individuals for routine examination, the positive rate of ANA titer >1:100 was 14.01%, of which the positive rate of female (19.05%) was higher than that of male (9.04%; P < 0.01). The positive rate of ANA titer >1:320 was 5.93%, of which the positive rate of female (8.68%) was higher than that of male (3.21%; P < 0.01). The specific antibodies were detected in 1489 of ANA‐positive people with titer >1:320, and the top three detected antibodies were anti‐Ro‐52 (212), AMA‐M2 (189), and anti‐SSA (144). The abnormal rate of blood routine test, liver function test, and other clinical indicators in AMA‐M2–positive population was significantly different from those in the control group. The abnormal rate of blood routine test, liver function test, and immune index in anti‐SSA–positive population was higher than those in control group.ConclusionThere was a high prevalence of ANA positive in healthy population. To avoid misdiagnosis, those who had symptoms of abdominal discomfort, pruritus, or fatigue with abnormal results of blood routine and liver function test should be examined for ANA, AMA‐M2, anti‐SSA as early as possible.

A Case of CD4+T-Cell Large Granular Lymphocytic Leukemia

We report here a case of a 59-yr-old man with CD4+ T-cell large granular lymphocytic leukemia (T-LGL). Peripheral blood examination indicated leukocytosis (45×109 cells/L) that consisted of 34% neoplastic lymphoid cells. Other laboratory results indicated no specific abnormalities except for serum antinuclear antibody titer (1:640), glucose (1.39 g/L), and hemoglobin A1c (7.7%) levels. Computed tomography indicated multiple small enlarged lymph nodes (<1 cm in diameter) in both the axillary and inguinal areas, a cutaneous nodule (1.5 cm in diameter) in the left suboccipital area, and mild hepatosplenomegaly. Bone marrow examination revealed hypercellular marrow that consisted of 2.4% neoplastic lymphoid cells. The neoplastic lymphoid cells exhibited a medium size, irregularly shaped nuclei, a moderate amount of cytoplasm, and large granules in the cytoplasm. Immunohistochemical analysis indicated CD3+, CD4+, T-cell receptor βF1+, granzyme B+, and TIA1+. Flow cytometric analysis of the neoplastic lymphoid cells revealed CD3+, cytoplasmic CD3+, CD4+, and CD7+. Cytogenetic analysis indicated an abnormal karyotype of 46,XY,inv(3)(p21q27),t(12;17)(q24.1;q21),del(13)(q14q22)[2]/46,XY[28]. The patient was diagnosed with CD4+ T-LGL and received chemotherapy (10.0 mg methotrexate). This is the second case of CD4+ T-LGL that has been reported in Korea.

Correlation between elevation of serum antinuclear antibody titer and decreased therapeutic efficacy in the treatment of Behçet’s disease with infliximab

Infliximab, an anti-TNF-α monoclonal antibody, administered to Behçet's disease (BD) patients in Japan with refractory intraocular inflammation, has shown excellent clinical results. However, some patients demonstrate a decreased response to infliximab during the course of the treatment. In the present study, we investigated the correlation between this reduced therapeutic effect and elevation of the serum antinuclear antibody (ANA) titers in patients with BD who were undergoing infliximab therapy. Seventeen patients (14 males and three females) with uveitis in BD who were undergoing treatment with infliximab for 2years or longer were enrolled. Their blood test results and clinical histories were obtained from medical records. One patient (5.9%) was ANA-positive prior to the initiation of infliximab, and 11 patients (64.7%) developed positive ANA during the therapy. The appearance of ANA was observed 6months after the initiation of the infliximab therapy, and its titers gradually increased. None of the patients showed lupus symptoms. Five patients (29.4%) have suffered from ocular inflammatory attacks since the sixth month from the initiation of infliximab treatment and all of them were ANA-positive. In contrast, four patients (23.5%) who were ANA-negative experienced no ocular attacks during the follow-up period. Here we report the positive conversion and subsequent elevation of serum ANA titers in some patients with BD after the initiation of infliximab therapy. Since all recurrences of uveitis were shown only in the ANA-positive patients, serum ANA titer may be a helpful biomarker for predicting the recurrence of ocular attacks in BD patients treated with anti-TNF-α antibody therapies.

首下がりを主徴とし舌萎縮を呈した全身性強皮症関連ミオパチーの１例

We report a 70-year-old man with a 5-year history of Raynaud's phenomenon and slow progression of weight loss, easy fatigability, muscle weakness, skin sclerosis, and dropped head sign. The patient was assumed to have motor neuron disease by his attending physician, and was referred to our hospital. Physical examination showed skin sclerosis on the fingers, hands, forearms, face, and neck. Neurological examination showed advanced systemic muscle atrophy and weakness, especially in the neck, tongue, and proximal limb muscles. Fasciculations were not observed in these involved muscles. Deep tendon reflexes were hypoactive and pathological reflexes were negative. Sensory disturbance was absent. Laboratory tests showed moderately elevated serum creatine kinase level, and increased serum antinuclear antibody titer (1:5120 with a nucleolar pattern). Needle electromyography showed a typical myogenic pattern in proximal muscles. The patient was diagnosed as having systemic sclerosis (SSc) with SSc-associated myopathy. Severe systemic muscle involvements, including dropped head sign and tongue atrophy, are rare manifestations in patients with SSc-associated myopathy. Our observations suggest that it is essential to pay attention to the dermatological findings of SSc in differential diagnosis of patients with muscular atrophy.

Hepatitis in SLE: Lupoid versus Autoimmune - A Case Report and Literature Review

Purpose: Introduction: We present a rare case of lupoid hepatitis masquerading as autoimmune hepatitis in a 32 year old African American male patient. Case Report: Patient is a 32 year old African-American male who was admitted for high grade fevers, chills, fatigue, anemia and leucopenia. He had severe myalgias, new onset itchy skin rash, abdominal pain, nausea without emesis, intermittent high grade fevers with chills, night sweats and significant weight loss in 3-4 month duration. Past medical history is significant for hypertension and cardiomyopathy. Physical examination showed temperature of 102 F with diffuse abdominal tende rness, hepatomegaly, generalized lymphadenopathy and a new onset macular rash over left axilla. Hepatitis - A, B and C panel was negative. Serum toxicology, HIV and EBV tests were negative. CT scan of chest, abdomen and pelvis with contrast showed hepatosplenomegaly, ascites and generalized lymphadenopathy. Serum antinuclear antibody titers were elevated and showed homogenous pattern. Liver biopsy showed extensive portal inflammation predominantly infiltrated by lymphocytes and plasma cells with multiple follicular centers, moderate interface necrosis, and early and focal bridge fibrosis. These findings on liver biopsy were confirmed by immunohistochemical staining. Patient was started on prednisone for possible autoimmune hepatitis based on elevated gamma-globulins and other clinical features while waiting for other autoantibody test results. Patient responded clinically to prednisone and plaquenil. Discussion: Hepatomegaly has been reported in up to 50 percent of patients with SLE. The most common cause of abnormal liver enzymes in SLE patients is drug-induced (Non-steroidal anti-inflammatory drugs). The other common causes are coincidental liver disease, thrombotic events with or without lupus anticoagulant including Budd-Chiari syndrome and veno-occlusive disease. A retrospective case review showed that out of 377 adult patients with SLE, only 5 (1.3%) had histologically confirmed liver damage with autoimmune features. Gamma globulins and IgG are sometimes elevated in autoimmune hepatitis. A retrospective chart review revealed a strong correlation between the anti-ribosomal P protein and lupus hepatitis. The antibody was present in all six patients with hepatitis compared to two out of twenty SLE patients without hepatitis. Conclusion: Lupoid hepatitis should always be suspected in a patient with active SLE and elevated liver enzymes. Although autoimmune hepatitis is rarely associated with SLE, it can be distinguished from lupoid hepatitis based on certain serum autoantibodies. Liver biopsy is not always reliable to distinguish these two entities.

Measurement of serum antinuclear antibody titer in dogs with and without systemic lupus erythematosus: 120 cases (1997–2005)

To determine serum antinuclear antibody (ANA) titers in dogs with systemic lupus erythematosus (SLE) and in dogs with related clinical and clinicopathologic findings. Retrospective case series. 120 dogs. Information that was evaluated included signalment, clinical signs, results of routine laboratory testing, ANA titer, and diagnosis. The most common clinical signs were arthralgia, myalgia, and stiffness (n = 41 [34.2%]); the most common clinicopathologic abnormality was thrombocytopenia (30 [25%]). Serum ANA titer was < 160 (seronegative) in 89 dogs (74.2%), 160 in 14 dogs (11.7%), 320 in 5 dogs (4.2%), and > or = 640 in 12 dogs (10%). Immune-mediated disease was confirmed in 40 dogs, 18 of which fulfilled the criteria for a definitive or probable diagnosis of SLE. Only 1 of 47 dogs with no major signs compatible with SLE had immune-mediated disease, compared with 26 of 57 dogs with 1 major sign and 13 of 16 dogs with > or = 2 major signs. Results suggested that measurement of ANA titer was not a useful diagnostic test in dogs without any major clinical or clinicopathologic abnormalities suggestive of SLE. In contrast, there was a good chance that results of the ANA assay would be positive and that the dog would be found to have immune-mediated disease if at least 2 major signs were evident. Findings suggest that it would be reasonable to limit the use of the ANA assay to those dogs that have at least 1 major sign compatible with a diagnosis of SLE.

Peribronchiolar Metaplasia: A Common Histologic Lesion in Diffuse Lung Disease and a Rare Cause of Interstitial Lung Disease

Peribronchiolar metaplasia (PBM) is a histologic lesion consisting of peribronchiolar metaplasia (PBM) of bronchiolar-type epithelium. Although widely recognized, PBM has received little attention in the pathologic literature and is not known to have clinical significance. We identified 15 cases in which PBM was the only major histologic finding in surgical lung biopsies from patients with interstitial lung disease (PBM-ILD), and we reviewed the clinical, imaging, and pathologic findings. The mean age was 57 years (range, 44-74 years) with 13 females and 2 males. One patient had been a welder with fume and asbestos exposure; another had pigeon exposure. Smoking history was available for 13 patients: three current smokers, one cocaine user, two former smokers, and seven never smokers. Three patients had collagen vascular disease. One had elevated serum antinuclear antibody titers. Pulmonary function data were available for 10 patients: one obstructive, five restrictive, two mixed obstructive and restrictive, and two normal. Computerized tomography in 7 patients showed mosaic attenuation in 3 patients and air trapping in 1 patient; no bronchiectasis, septal lines, or honeycombing were seen in any cases. All 11 patients with available follow-up are alive; 4 of them have experienced symptomatic improvement (follow-up, 0.6-6.9 years; mean, 2.4 years). PBM was found focally in other interstitial lung diseases, which were assessed for this lesion: 59% of usual interstitial pneumonia (17 of 29), 50% of nonspecific interstitial pneumonia (10 of 20), desquamative interstitial pneumonia (3 of 6), hypersensitivity pneumonitis (9 of 18), and 11% of respiratory bronchiolitis (2 of 18). In summary, PBM is a common histologic finding in various interstitial lung disorders. It is rarely the sole major lung biopsy finding in patients presenting with interstitial lung disease (PBM-ILD). Patients are mostly older women, with mild symptoms and CT findings. Survival appears to be favorable.

Chronic encephalitis, epilepsy, and cerebrovascular immune complex deposits

Refractory epilepsy, electroencephalographic abnormalities, progressive hemiplegia, and contralateral hemicerebral atrophy developed in a previously healthy 3-year, 9-month-old girl. Extensive laboratory testing showed elevated serum antinuclear antibody titers, cerebrospinal fluid oligoclonal bands, and elevated immunoglobulin G (IgG): albumin ratio, IgG index, and IgG synthesis rate. Pathological study of a subtotal hemispherectomy specimen revealed widespread cerebral vasculitis with immunofluorescence staining for IgG, IgM, IgA, C3, and Clq, and ultrastructural evidence of vascular injury in addition to severe cortical atrophy with marked neuronal loss. Cerebrospinal fluid abnormalities in other reported patients suggest that immunological abnormalities may not be unique to this girl. These data suggest possible immunopathogenetic mechanisms in these patients.

Natural killer cell activity and serum autoantibodies in women with postpartum thyroiditis.

Postpartum thyroiditis (PPT) is a form of painless lymphocytic thyroiditis which is thought to be caused by an exacerbation of underlying subclinical autoimmune thyroid disease during a postpartum period of immune rebound. The purposes of this study were to analyze natural killer cell (NK) functional activity and antibody-dependent cell-mediated cytotoxicity (ADCC) of peripheral blood mononuclear cells in patients with PPT compared to those in normal nonpostpartum and postpartum women. NK activity and ADCC were determined by specific lysis of 51Cr-labeled K562 human erythroleukemia tumor cells at varying effector (mononuclear cell) to target cell ratios. Nineteen PPT patients between 4-9 months [mean, 6.5 +/- 0.4 (+/- SE)] postpartum were compared to 20 nonpostpartum women, 31 healthy women between 4-9 months (6.7 +/- 0.3) postpartum, and 14 women 2 days after delivery. There were significant differences in the NK functional activities of the 4 groups (F = 7.95; P = 0.0002). The mean NK activities, as measured by percent specific lysis at an effector to target cell ratio of 10:1, were 31.1 +/- 3.3%, 20.9 +/- 2.3%, 22.5 +/- 2.8%, and 11.5 +/- 2.0% in the nonpostpartum, PPT, postpartum, and 2-day postpartum groups, respectively. Specific lysis by ADCC was not significantly different from lysis by NK activity in any group. The PPT, postpartum, and 2-day postpartum groups had significantly lower NK activity compared to that in nonpostpartum women (P less than 0.05). Both the PPT and postpartum women had higher NK activities than the 2-day postpartum women (P less than 0.05). However, there were no significant differences in the NK activities of the PPT patients compared to those of the healthy postpartum women. Patients with PPT were also found to have associated autoimmune dysfunction. The PPT group had significantly higher serum antinuclear antibody titers; 8 of 24 patients (33%) had titers of 1:160 or greater compared to only 2 of 29 healthy postpartum women (7.4%; P less than 0.05). Seven of the PPT patients had serum immune complexes, and 3 had TSH receptor antibodies. We conclude that functional NK activity and ADCC in peripheral lymphocytes of PPT patients are not different from those in healthy postpartum women; however, the postpartum women had significantly decreased activity compared to that in nonpostpartum women. These data emphasize the importance of studying healthy postpartum women in investigations of PPT, since the immunological changes in pregnancy and the postpartum period remain largely undefined.

Lupus Pleuritis: Clinical Features and Pleural Fluid Characteristics with Special Reference to Pleural Fluid Antinuclear Antibodies

Eighteen patients with lupus erythematosus (LE) and pleural effusions were evaluated. Fourteen patients had lupus pleuritis and four had pleural effusions of other etiologies. All patients were symptomatic, and the presenting signs and symptoms did not help distinguish between lupus pleuritis and pleural effusions of other causes. The presence of LE cells confirmed the diagnosis of lupus pleuritis in seven of eight patients. In 11 of 13 patients with lupus pleuritis, the pleural fluid antinuclear antibody (ANA) titer was greater than or equal to 1:160, and in nine of 13 patients with lupus pleuritis, the pleural fluid to serum (PF/S) ANA ratio was greater than or equal to 1. In the four patients with LE and a pleural effusion of another etiology, the pleural fluid ANA titer was negative in two and low titer in two (1:40, 1:80); the pleural fluid to serum ANA titer was always less than one. Of 67 patients with pleural effusions of other etiologies, the pleural fluid ANA was negative. The signs and symptoms of lupus pleuritis are nonspecific, however; the findings of LE cells in pleural fluid confirms the diagnosis and a high pleural fluid ANA titer (greater than or equal to 1:160) and a PF/S ANA ratio of greater than or equal to 1 strongly supports the diagnosis.

Solitary Renal Calix

ALTHOUGH many mammalian kidneys have a solitary calix or unipapillary kidney, to the best of our knowledge, only one such example in the human has been reported.1We report a second case. Report of a Case Proteinuria was first detected in our patient (a 26-year-old woman) at the age of 11 years. Urinary protein determinations ranged from trace to 2+. Her blood pressure (BP) was 130/84 mm Hg. No additional records were available until age 23 years, when she was admitted for acute gastroenteritis. At that time, the serum albumin level was 2.1 g/dl, with an otherwise normal serum protein electrophoresis level. A serum antinuclear antibody titer was undetectable. Urine culture and sensitivity showed no growth. Urine protein was 3+ to 4+ on five determinations. The urine sediment level was normal, and the creatinine clearance was 67 ml/min. Three years later, the results of a routine examination disclosed mild

Granulocytopenia and hemolytic anemia as complications of propylthiouracil therapy.

PROPYLTHIOURACIL is commonly used in the treatment of hyperthyroidism in adults and children. Reported toxic effects of PTU have included leukopenia and granulocytopenia , 1 bone marrow hypoplasia with pancytopeniai2, 3 hypoprothrombine mia,4 rheumatic syndromes with or without associated serum antinuclear antibody titers or positive lupus erythematosus cell preparations, 5-9 and splenomegaly. 9 We have seen no report of PTU-induced hemolytic anemia, the complication observed in the child described below.

Antinuclear antibodies. Clinical significance of titers and fluorescence patterns.

Eighty-one patients with sera positive for antinuclear antibodies were studied to determine the clinical significance of serum antinuclear antibody titers and immunofluorescent nuclear staining patterns. Attempts were made to (1) determine clinically significant serum ANA titers for various connective tissue diseases; (2) note the specificity of immunofluorescent nuclear staining patterns among various connective tissue diseases; (3) observe the spectrum of serum ANA titers and immunofluorescent nuclear staining patterns among various non-rheumatic diseases; (4) correlate serum ANA titers and immunofluorescent nuclear patterns with the clinical courses of connective tissue diseases. No clinically significant serum ANA titer could be determined either for specific connective tissue diseases or for connective tissue diseases in general, although patients with titers of 1:160 or above more often than not had clinically evident connective-tissue disease. Furthermore, no pattern of nuclear fluorescence proved to be specific for any given clinical syndrome, with a variety of nuclear fluorescent patterns being observed in specific connective-tissue disorders and other non-rheumatic diseases. Only a few correlations could be made between serum ANA titer, nuclear fluorescent pattern, and the clinical courses of connective-tissue disorders. These correlations occurred most frequently with lupus nephritis.

Systemic Lupus Erythematosus With Cutaneous Ulceration

A patient with systemic lupus erythematosus who had cutaneous ulceration as the initial complaint was followed up through three exacerbations and two remissions in ulcer size. A close correlation was found between serum complement titer, serum antinuclear antibody titer, corticosteroid dose, and ulcer size.