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246 High titer ana with anti-dfs70 alone is not to be considered a valid criterion for lupus
  1. E Chan1,
  2. L Andrade2,
  3. J Damoiseaux3 and
  4. M Satoh4
  1. 1USA
  2. 2Universidade Federal de São Paulo, Rheumatology, Sao Paulo, Brazil
  3. 3Maastricht University Medical Centre, Central Diagnostic Laboratory, Maastrricht, The Netherlands
  4. 4University of Occupational and Environmental Health, Clinical Nursing, Kitakyushu, Japan

Abstract

Background and aims Positive ANA is one of Criteria for Classification of SLE for ACR and SLICC. As a follow-up to the International Consensus on ANA Patterns (ICAP) initiative (ANApatterns.org), the relevance of each ANA pattern is being re-evaluated.

Methods ANA test at 1/80 screening dilution was performed in 269 sequentially selected patients with SLE diagnosis, 918 healthy individuals, and 558 patients with non-SARD conditions. ANA interpretation was the consensus of 3 independent readers using 2 HEp-2 cell slide brands at 400x mag. Conversely, sequentially selected individuals presenting >1/640 titer Nuclear Dense Fine Speckled (DFS) ANA pattern (AC-2) in a large clinical laboratory within a 2 year period had the diagnosis assessed by interview with the respective physician.

Results Among 269 consecutive SLE patients, 96.3% had a positive ANA with the following principal nuclear patterns: homogeneous (29.3%), coarse speckled (14.7%), fine speckled (40.1%). Only one patient (0.3%) had the DFS pattern and the reactivity to DFS70 confirmed by ELISA. Conversely, among 118 ANA+ healthy individuals and 102 ANA+ patients with miscellaneous non-SARD conditions, 33% and 17% presented the DFS pattern, respectively. In addition, the 327 consecutive high-titer DFS individuals presented mostly non-SARD conditions or non-specific clinical presentation. Only 7 had possibly SARD-related presentations: 1 anti-phospholipid syndrome, 1 “possible” SLE (polyarthritis, arthritis, chronic urticaria), 1 WG, 1 DLE, 1 PBC, and 1 RA.

Conclusions Well-defined anti-DFS ANA, confirmed by antigen-specific reflex testing, should not be considered a criterion for SLE - either in the ACR or SLICC classification criteria.

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