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Antinuclear Antibody Testing İn A Turkish Pediatrics Clinic: İs İt Always Necessary?

Yıl 2019, Cilt: 7 Sayı: Ek - IRUPEC 2019 Kongresi Tam Metin Bildirileri, 163 - 169, 10.12.2019

Öz

The term anti-nuclear antibody (ANA) is used to define a large group of autoantibodies which specifically bind to nuclear elements. Although healthy individuals may also have ANA positivity, the measurement of ANA is generally used in the diagnosis of autoimmune disorders. However, various studies have shown that ANA testing may be overused, especially in pediatrics clinics. Our aim was to investigate the reasons for antinuclear antibody (ANA) testing in the general pediatrics and pediatric rheumatology clinics of our hospital and to determine whether ANA testing was ordered appropriately by evaluating chief complaints and the ultimate diagnoses of these cases.
Methods:
The medical records of pediatric patients in whom ANA testing was performed between January 2014 and June 2016 were retrospectively evaluated. Subjects were grouped according to the indication for ANA testing and ANA titers.
Results:
ANA tests were ordered in a total of 409 patients during the study period, with 113 positive ANA results. The ANA test was ordered mostly due to joint pain (50% of the study population). There was an increased likelihood of autoimmune rheumatic diseases (ARDs) with higher ANA titer. The positive predictive value of an ANA test was 16% for any connective tissue disease and 13% for lupus in the pediatric setting.
Conclusion:
in the current study, more than one-fourth of the subjects were found to have ANA positivity, while only 15% were ultimately diagnosed with ARDs. Our findings underline the importance of an increased awareness of correct indications for ANA testing.

Kaynakça

  • References 1 Agarwal M, Sawhney S. Laboratory tests in pediatric rheumatology. Indian J Pediatr. 2010;77(9):1011–6. 2 Mehta J. Laboratory testing in pediatric rheumatology. Pediatr Clin N Am. 2012;59(2):263–84. 3 Jarvis JN. Commentary-ordering lab tests for suspected rheumatic disease. Pediatr Rheumatol. 2008;6:19. 4 Breda L, Nozzi M, De Sanctis S, Chiarelli F. Laboratory tests in the diagnosis and follow-up of pediatric rheumatic diseases: an update. Semin Arthritis Rheum. 2010;40(1):53–72. 5 Fritzler MJ, Wiik A, Fritzler ML, Barr SG. The use and abuse of commercial kits used to detect autoantibodies. Arthritis Res Ther. 2003;5(4):192–204. 6 Leslie D, Lipsky P, Notkins AL. Autoantibodies as predictors of disease. J Clin Invest. 2001;108(10):1417–22. 7 Satoh M, Vázquez-Del Mercado M, Chan EK. Clinical interpretation of antinuclear antibody tests in systemic rheumatic diseases. Mod Rheumatol. 2009;19(3):219–28. 8 Heiligenhaus A, Niewerth M, Ganser G, Heinz C, Minden K, German Uveitis in Childhood Study Group Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines. Rheumatology. 2007 Jun;46(6):1015–9. 9 Karakeçe E, Atasoy AR, Çakmak G, Tekeoglu I, Harman H, Çiftci IH. Bir üniversite hastanesinde antinükleer antikor pozitiflikleri. Turk J Immunol. 2014;2(1):5–8. 10 Agmon-Levin N, Damoiseaux J, Kallenberg C, Sack U, Witte T, Herold M, et al. International recommendations for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies. Ann Rheum Dis. 2014 Jan;73(1):17–23. 11 Alarcon-Segovia D, Fishbein E, Alcalá H, Olguín-Palacios E, Estrada-Parra S. The range and specificity of antinuclear antibodies in systematic lupus erythematosus. Clin Exp Immunol. 1970 Apr;6(4):557–571. 12 Mahler M, Ngo JT, Schulte-Pelkum J, Luettich T, Fritzler MJ. Limited reliability of the indirect immunofluorescence technique for the detection of anti-Rib-P antibodies. Arthritis research & therapy. 2008;10(6):R131. 13 Tan E, Feltkamp T, Smolen J, Butcher B, Dawkins R, Fritzler M, et al. Range of antinuclear antibodies in “healthy” individuals. Arthritis Rheum. 1997;40(9):1601–11. 14 Malleson PN, Mackinnon MJ, Sailer-Hoeck M, Spencer CH. Review for the generalist: the antinuclear antibody test in children-When to use it and what to do with a positive titer. Pediatr Rheumatol. 2010;8:27. 15 Li Q-Z, Karp DR, Quan J, Branch VK, Zhou J, Lian Y, et al. Risk factors for ANA positivity in healthy persons. Arthritis Res Ther. 2011;13(2):R38. 16 Arroyave CM, Giambrone MJ, Rich KC, Walaszek M. The frequency of antinuclear antibody (ANA) in children by use of mouse kidney (MK) and human epithelial cells (HEp-2) as substrates. J Allergy Clin Immunol. 1988 Nov;82(5 Pt 1):741–4. 17 Wananukul S, Voramethkul W, Kaewopas Y, Hanvivatvong O. Prevalence of Positive Antinuclear An-tibodies in Healthy Children. Allergy Immunol. 2005;23(2-3):153–7. 18 Von Mühlen CA, Tan EM. Autoantibodies in the diagnosis of systemicrheumatic diseases. Semin Arthritis Rheum. 1995;24(5):323–58. 19 Dayer E, Dayer J-M, Roux-Lombard P. Primer: the practical use of biological markers of rheumatic and systemic inflammatory diseases. Nat Clin Pract Rheumatol. 2007;3(9):512–20. 20 McGhee JL, Kickingbird LM, Jarvis JN. Clinical utility of antinuclear antibody tests in children. BMC pediatr. 2004;4:13. 21 Perilloux B, Shetty A, Leiva L, Gedalia A. Antinuclear antibody (ANA) and ANA profile tests in children with autoimmune disorders: a retrospective study. Clin Rheumatol. 2000;19(3):200–3. 22 Narain S, Richards HB, Satoh M, Sarmiento M, Davidson R, Shuster J, et al. Diagnostic accuracy for lupus and other systemic autoimmune diseases in the community setting. Arch Intern Med. 2004;164(22):2435–41. 23. Kavanaugh A, Tomar R, Reveille J, Solomon DH, Homburger HA. Guidelines for clinical use of the antinuclear antibody test and tests for specific autoantibodies to nuclear antigens. Arch Pathol Lab Med. 2000;124(1):71–81. 24 Spencer-Green G. Outcomes in primary Raynaud phenomenon: a meta-analysis of the frequency, rates and predictors of transition to secondary diseases. Arch Intern Med. 1998;158(6):595–600. 25 Zimmerman SA, Ware RE. Clinical significance of the antinuclear antibody test in selected children with idiopathic thrombocytopenic purpura. J Pediatr Hematol Oncol. 1997;19(4):297–303.
Yıl 2019, Cilt: 7 Sayı: Ek - IRUPEC 2019 Kongresi Tam Metin Bildirileri, 163 - 169, 10.12.2019

Öz

Kaynakça

  • References 1 Agarwal M, Sawhney S. Laboratory tests in pediatric rheumatology. Indian J Pediatr. 2010;77(9):1011–6. 2 Mehta J. Laboratory testing in pediatric rheumatology. Pediatr Clin N Am. 2012;59(2):263–84. 3 Jarvis JN. Commentary-ordering lab tests for suspected rheumatic disease. Pediatr Rheumatol. 2008;6:19. 4 Breda L, Nozzi M, De Sanctis S, Chiarelli F. Laboratory tests in the diagnosis and follow-up of pediatric rheumatic diseases: an update. Semin Arthritis Rheum. 2010;40(1):53–72. 5 Fritzler MJ, Wiik A, Fritzler ML, Barr SG. The use and abuse of commercial kits used to detect autoantibodies. Arthritis Res Ther. 2003;5(4):192–204. 6 Leslie D, Lipsky P, Notkins AL. Autoantibodies as predictors of disease. J Clin Invest. 2001;108(10):1417–22. 7 Satoh M, Vázquez-Del Mercado M, Chan EK. Clinical interpretation of antinuclear antibody tests in systemic rheumatic diseases. Mod Rheumatol. 2009;19(3):219–28. 8 Heiligenhaus A, Niewerth M, Ganser G, Heinz C, Minden K, German Uveitis in Childhood Study Group Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines. Rheumatology. 2007 Jun;46(6):1015–9. 9 Karakeçe E, Atasoy AR, Çakmak G, Tekeoglu I, Harman H, Çiftci IH. Bir üniversite hastanesinde antinükleer antikor pozitiflikleri. Turk J Immunol. 2014;2(1):5–8. 10 Agmon-Levin N, Damoiseaux J, Kallenberg C, Sack U, Witte T, Herold M, et al. International recommendations for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies. Ann Rheum Dis. 2014 Jan;73(1):17–23. 11 Alarcon-Segovia D, Fishbein E, Alcalá H, Olguín-Palacios E, Estrada-Parra S. The range and specificity of antinuclear antibodies in systematic lupus erythematosus. Clin Exp Immunol. 1970 Apr;6(4):557–571. 12 Mahler M, Ngo JT, Schulte-Pelkum J, Luettich T, Fritzler MJ. Limited reliability of the indirect immunofluorescence technique for the detection of anti-Rib-P antibodies. Arthritis research & therapy. 2008;10(6):R131. 13 Tan E, Feltkamp T, Smolen J, Butcher B, Dawkins R, Fritzler M, et al. Range of antinuclear antibodies in “healthy” individuals. Arthritis Rheum. 1997;40(9):1601–11. 14 Malleson PN, Mackinnon MJ, Sailer-Hoeck M, Spencer CH. Review for the generalist: the antinuclear antibody test in children-When to use it and what to do with a positive titer. Pediatr Rheumatol. 2010;8:27. 15 Li Q-Z, Karp DR, Quan J, Branch VK, Zhou J, Lian Y, et al. Risk factors for ANA positivity in healthy persons. Arthritis Res Ther. 2011;13(2):R38. 16 Arroyave CM, Giambrone MJ, Rich KC, Walaszek M. The frequency of antinuclear antibody (ANA) in children by use of mouse kidney (MK) and human epithelial cells (HEp-2) as substrates. J Allergy Clin Immunol. 1988 Nov;82(5 Pt 1):741–4. 17 Wananukul S, Voramethkul W, Kaewopas Y, Hanvivatvong O. Prevalence of Positive Antinuclear An-tibodies in Healthy Children. Allergy Immunol. 2005;23(2-3):153–7. 18 Von Mühlen CA, Tan EM. Autoantibodies in the diagnosis of systemicrheumatic diseases. Semin Arthritis Rheum. 1995;24(5):323–58. 19 Dayer E, Dayer J-M, Roux-Lombard P. Primer: the practical use of biological markers of rheumatic and systemic inflammatory diseases. Nat Clin Pract Rheumatol. 2007;3(9):512–20. 20 McGhee JL, Kickingbird LM, Jarvis JN. Clinical utility of antinuclear antibody tests in children. BMC pediatr. 2004;4:13. 21 Perilloux B, Shetty A, Leiva L, Gedalia A. Antinuclear antibody (ANA) and ANA profile tests in children with autoimmune disorders: a retrospective study. Clin Rheumatol. 2000;19(3):200–3. 22 Narain S, Richards HB, Satoh M, Sarmiento M, Davidson R, Shuster J, et al. Diagnostic accuracy for lupus and other systemic autoimmune diseases in the community setting. Arch Intern Med. 2004;164(22):2435–41. 23. Kavanaugh A, Tomar R, Reveille J, Solomon DH, Homburger HA. Guidelines for clinical use of the antinuclear antibody test and tests for specific autoantibodies to nuclear antigens. Arch Pathol Lab Med. 2000;124(1):71–81. 24 Spencer-Green G. Outcomes in primary Raynaud phenomenon: a meta-analysis of the frequency, rates and predictors of transition to secondary diseases. Arch Intern Med. 1998;158(6):595–600. 25 Zimmerman SA, Ware RE. Clinical significance of the antinuclear antibody test in selected children with idiopathic thrombocytopenic purpura. J Pediatr Hematol Oncol. 1997;19(4):297–303.
Toplam 1 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Konferans Bildirisi (Tam Metin)
Yazarlar

Erhan Aygün

Yayımlanma Tarihi 10 Aralık 2019
Kabul Tarihi 16 Ocak 2020
Yayımlandığı Sayı Yıl 2019 Cilt: 7 Sayı: Ek - IRUPEC 2019 Kongresi Tam Metin Bildirileri

Kaynak Göster

Vancouver Aygün E. Antinuclear Antibody Testing İn A Turkish Pediatrics Clinic: İs İt Always Necessary?. pediatr pract res. 2019;7(Ek):163-9.