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400 Ana-negative sle: re-evaluation in an international inception cohort
  1. M Choi1,
  2. A Clarke1,
  3. St Pierre Y.2,
  4. J Hanly3,
  5. M Urowitz4,
  6. D Gladman4,
  7. S Pike2,
  8. M Fritzler5 and
  9. SI SLICCInvestigators Group1
  1. 1University of Calgary, Medicine, Calgary, Canada
  2. 2McGill University, Medicine, Medicine, Canada
  3. 3Queen Elizabeth II Health Sciences Centre and Dalhousie University, Medicine, Halifax, Canada
  4. 4University of Toronto, Medicine, Toronto, Canada
  5. 5Allegheny Health Network, Medicine, Pittsburgh, USA

Abstract

Background and aims The prevalence of ANA-negative SLE is reportedly 5%–20%. Cytoplasmic or mitotic cell indirect immunofluorescence (IIF) patterns are usually reported as ANA-negative. This study examined the prevalence of ANA-negativity (no intracellular IIF pattern) and pure cytoplasmic and/or mitotic IIF patterns (CMP) in the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort and examined demographic, clinical and autoantibody associations.

Methods Three groups were examined 1) ANA-positive (presence of nuclear IIF pattern), 2) ANA-negative (no IIF pattern), and 3) pure CMP. ANA were detected by IIF on HEp-2000 substrate, SLE-related autoantibodies by laser bead immunoassay, and anti-dsDNA and anti-dense fine speckles 70 (DFS70) by chemiluminescence immunoassay.

Results 1137 patients were included; 89.9% were female. 92.3% were ANA-positive, 6.2% were ANA-negative, and 1.5% had a CMP. In the multivariate analysis (Tables 1 and 2), patients from Canada (Odds Ratio (OR) 2.07 [95% CI: 1.28, 3.36]) or with anti-DFS70 (OR 4.45 [95% CI: 1.37, 14.39]) were more likely to be ANA-negative or have CMP. Patients of Asian descent (OR 0.34 [95% CI: 0.13, 0.86]) or with anti-dsDNA (OR 0.53 [95% CI: 0.30, 0.94]), anti-SSA/Ro60 (OR 0.51 [95% CI: 0.30, 0.87]), or anti-UI-RNP (OR 0.35 [95% CI: 0.17, 0.70]) were less likely to be ANA-negative or CMP.

Abstract 400 Table 1
Abstract 400 Table 1

Baseline, univariate and multivariate associations of demographic and clinical profiles of ANA-positive (presence of nuclear IIF pattern), ANA-negative (no IIF pattern), and pure cytoplasmic/mitotic (CMP) groups

Abstract 400 Table 2
Abstract 400 Table 2

Baseline, univariate and multivariate associations of autoantibody profiles of ANA-positive (presence of nuclear IIF pattern), ANA-negative (no IIF pattern), and pure cytoplasmic/mitotic (CMP) groups

Conclusions In newly diagnosed SLE, the prevalence of ANA-negativity was at the lower end (6.2%) of the range previously published and an additional 1.5% had a CMP pattern. The prevalence of true ANA-negativity will likely decrease as future guidelines are expected to recommend that non-nuclear patterns, such as CMP, are also reported.

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