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ANA-specific antibodies, ANA patterns, anti-ds-DNA results, and clinical diagnosis: a laboratory and clinical audit

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Abstract

The diagnosis of systemic autoimmune diseases (SAID) is challenging, due to overlapping features with other non-immune disorders. Anti-nuclear antibodies (ANA)/anti-cellular antibodies are the sensitive screening tests but anti-double-stranded-deoxyribonucleic acid-antibody (anti-ds-DNA) and ANA-specific antibodies are specific for SAID. We aimed to look at ANA-specific antibodies in our patients and correlated them with ANA patterns, anti-ds-DNA, and clinical diagnosis for proper interpretation and better patient management cost-effectively. A retrospective data analysis of 641 patients was done (1st of February 2019 to 31st of July 2021) who were tested for ANA-specific antibodies at the Immunology Department of Indus Hospital and Health Network. ANA and anti-ds-DNA results and clinical diagnosis were also analyzed for ANA-specific antibody-positive patients. Descriptive data were presented in mean ± standard deviation and frequency percentages whereas inferential data were analyzed with a chi-square test for association between ANA-specific antibodies status, ANA, anti-ds-DNA, and clinical features. ANA-specific antibodies test revealed positivity for at least one autoantibody in 245 (38.2%) patients. Of these, ANA was tested in 206 patients reactive for ANA-specific antibodies and found positive in 195 (95%) as compared to negative (< 0.001). Speckled and homogenous were predominant ANA patterns in ANA-specific antibody-positives (56% and 42% respectively). Multiple ANA patterns were found in 18 patients most commonly with systemic lupus erythematosus (SLE) and mixed connective tissue disorder (MCTD). Anti-SSA were the most common ANA-specific antibodies (50%) and were mostly found in sera with speckled (61/97) and homogenous (38/97) patterns and associated mostly with SLE (48%) and Sjogren’s syndrome (86%). Among ANA-negative patients, anti-SSA were the most common antibodies (n = 5). Anti-ds-DNA was found in 66% of SLE patients along with another ANA-specific antibody. This study showed that testing for ANA-specific antibodies cannot be gated on ANA patterns. Also, there is a redundancy of these antibodies with various clinical diagnoses. Moreover, they are useful in making a diagnosis in ANA-negative patients as well with clinical suspicion.

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Acknowledgements

We are extremely grateful to Mr. Jaffer Bin Baqar (Sr. Manager Research, Getz Pharma) for his assistance with the statistical analysis and data presentations. We acknowledge the efforts of Ms. Mamona Mushtaq to help us with extracting and compiling data.

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Authors and Affiliations

  1. Department of Pathology and Department of Medicine and Allied, The Indus Hospital and Health Network (IHHN), Karachi, Pakistan

    Sabiha Anis

  2. Department of Pathology, The Indus Hospital and Health Network (IHHN), Karachi, Pakistan

    Areej Fatima, Sidra Abdul Jabbar & Tayyab Arain

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  1. Sabiha Anis
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  2. Areej Fatima
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Dr. Sabiha Anis. The first and final draft of the manuscript was written by Dr. Sabiha Anis and all authors reviewed and commented on the manuscript for final version of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sabiha Anis.

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Anis, S., Fatima, A., Abdul Jabbar, S. et al. ANA-specific antibodies, ANA patterns, anti-ds-DNA results, and clinical diagnosis: a laboratory and clinical audit. Immunol Res 71, 267–275 (2023). https://doi.org/10.1007/s12026-022-09347-z

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