Çocuk Romatoloji Polikliniğine Anti-Nükleer Antikor (ANA) Pozitifliği ile Yönlendirilen Hastaların Özellikleri

Yıl 2019, , 13 - 18, 21.03.2019

Yelda Bilginer

https://doi.org/10.12956/tjpd.2018.345

Cited By: 1

Öz

Amaç: Anti-nükleer antikor (ANA), hücre çekirdeği yapısında yer alan yapılara karşı gelişen antikorlardır. Otoimmün

hastalıklarda sıklıkla pozitif olabildiği gibi sağlıklı bireylerde de saptanabilir. Çalışmamızda, kliniğimize ANA pozitifliği

ile yönlendirilen hastaların son tanılarını ve klinik izlemde romatolojik hastalık geliştirip geliştirmediğini ortaya koymayı

amaçladık.

Gereç ve Yöntemler: 2014-2016 yılları arasında Çocuk Romatoloji Bilim Dalı’na ANA pozitifliği nedeniyle yönlendirilen

0-18 yaş arası olgular dahil edildi.

Bulgular: Çalışmaya 43 olgu dahil edildi. Yönlendirilen hastaların ilk başvuru yakınmaları sırasıyla; 19’unda (%44.2) eklem

bulguları, 13’ünde (%30.2) mukokütanöz bulgular, 6’sında (%14) hematolojik bulgular, 3’ünde (%7) nörolojik bulgular,

2’sinde (%4.6) Raynaud fenomeniydi. Hastaların 34’ünde (%79) ANA 1/160 ve üzerinde titrede pozitifti; 9’unda (%21)

ise anlamlı olmayan düşük titrelerde saptanmıştı. Hastaların 23’üne (%53.4) romatolojik hastalık tanısı konulurken; 20

hastada romatizmal hastalık olmadığı saptanmıştır. ANA pozitif (n=34) olan hastalarla ANA negatif (n=9) olan hastaların

klinik ve laboratuvar özellikleri açısından anlamlı fark saptanmamıştır. Romatolojik hastalık tespit edilen ile edilmeyen

hastalar karşılaştırıldığında, romatolojik hastalığı olanlarda artralji, artrit ve Raynoud fenomeni anlamlı olarak daha fazla,

otoantikor varlığı daha sık ve akut faz reaktan düzeyleri anlamlı olarak daha yüksekti. Hastaların medyan (minimummaksimum)

takip süresi 24 (6-37) aydı.

Sonuç: ANA testinin, özellikle romatolojik hastalığı telkin eden klinik bulgular varlığında istenmesinin daha uygun olacağı

düşünülmektedir

Anahtar Kelimeler

Anti-nükleer antikor, Jüvenil idiyopatik artrit, Romatolojik hastalık

Characteristics of Patients Referred to the Pediatric Rheumatology Polyclinic with Anti-Nuclear Antibody (ANA) Positivity

Öz

Objective: Anti-nuclear antibodies (ANA) develop against the structures found in the cell nucleus. These antibodies can

be positive in the autoimmune disorders, but they can be also detected in healthy people. The objective of our study

was to determine the definitive diagnosis of the patients referred to our clinic due to the ANA positivity and find out

whether they develop rheumatologic disorders during the clinical follow-up.

Material and Methods: We have reviewed the medical files of children who were referred to the pediatric rheumatology

department between 2014 and 2016 with ANA positivity.

Results: 43 subjects were enrolled in the study. The complaints of the referred patients at first presentation were

as follows: joint symptoms in 19 patients (44.2%), mucocutaneous symptoms in 13 patients (30.2%), hematological

findings in 6 patients (14%), neurological symptoms in 3 patients (7%), and Raynaud’s phenomenon in 2 patients

(4.6%). 34 patients (79%) had a positive ANA titer ≥ 1/160. The ANA titer level was below 1/160 in 9 patients (21%).

23 patients (53.4%) were diagnosed with a rheumatologic disease, while 20 patients did not have any rheumatologic

disorder. There was no significant difference between the ANA-positive (n=34) and ANA-negative (n=9) patients with

regards to the clinical and laboratory characteristics. The comparison of the patients with and without a rheumatologic

disorder revealed that the presence of auto-antibodies was more common and acute phase reactant levels were higher

in the disease group for arthralgia, arthritis and Raynaud’s phenomenon.

Conclusion: We conclude that ANA testing should preferably be requested in the presence of clinical findings associated

with rheumatologic disorders.

Anahtar Kelimeler

Anti-nuclear antibody, Juvenile idiopathic arthritis, Rheumatologic disease

Kaynakça

• 1. Fritzler MJ. Choosing wisely: Review and commentary on antinuclear antibody (ANA) testing. Autoimmun Rev 2016;15:272-80.
• 2. 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. American College of Pathologists. Arch Pathol Lab Med 2000;124:71-81.
• 3. Watanabe A, Kodera M, Sugiura K, Usuda T, Tan EM, Takasaki Y, et al. Anti-DFS70 antibodies in 597 healthy hospital workers. Arthritis Rheum 2004;50:892-900.
• 4. Martini G, Foeldvari I, Russo R, Cuttica R, Eberhard A, Ravelli A, et al. Systemic sclerosis in childhood: clinical and immunologic features of 153 patients in an international database. Arthritis Rheum 2006;54:3971-8.
• 5. Scalapino K, Arkachaisri T, Lucas M, Fertig N, Helfrich DJ, Londino AV Jr, et al. Childhood onset systemic sclerosis: classification, clinical and serologic features, and survival in comparison with adult onset disease. J Rheumatol 2006;33:1004-13.
• 6. Kishi T, Miyamae T, Hara R, Nakajima S, Imagawa T, Mori M, et al. Clinical analysis of 50 children with juvenile dermatomyositis. Mod Rheum 2013;23:311-7.
• 7. Gowdie PJ, Allen RC, Kornberg AJ, Akikusa JD. Clinical features and disease course of patients with juvenile dermatomyositis. Int J Rheum Dis 2013;16:561-7.
• 8. Bader-Meunier B, Armengaud JB, Haddad E, Salomon R, Deschênes G, Koné-Paut ,et al. Initial presentation of childhoodonset systemic lupus erythematosus: a French multicenter study. J Pediatr 2005;146:648-53.
• 9. Hiraki LT, Benseler SM, Tyrrell PN, Hebert D, Harvey E, Silverman ED. Clinical and laboratory characteristics and long-term outcome of pediatric systemic lupus erythematosus: A longitudinal study. J Pediatr 2008;152:550-6.
• 10. Berntson L, Andersson Gare B, Fasth A, Herlin T, Kristinsson J, Lahdenne P, et al. Incidence of juvenile idiopathic arthritis in the Nordic countries. A population based study with special reference to the validity of the ILAR and EULAR criteria. J Rheumatol 2003;30:2275-82.
• 11. Kasapcopur O, Ozbakir F, Arisoy N, Ingol H, Yazici H, Ozdogan H. Frequency of antinuclear antibodies and rheumatoid factor in healthy Turkish children. Turk J Pediatr 1999;41:67-71.
• 12. Aho K, Koskela P, Makitalo R, Heliovaara M, Palosuo T. Antinuclear antibodies heralding the onset of systemic lupus erythematosus. J Rheumatol 1992;19:1377-9.
• 13. Cabral DA, Petty RE, Fung M, Malleson PN. Persistent antinuclear antibodies in children without identifiable inflammatory rheumatic or autoimmune disease. Pediatrics 1992;89:441-4.
• 14. Deane PM, Liard G, Siegel DM, Baum J. The outcome of children referred to a pediatric rheumatology clinic with a positive antinuclear antibody test but without an autoimmune disease. Pediatrics 995;95:892-5.
• 15. Menor Almagro R, Rodriguez Gutierrez JF, Martin-Martinez MA, Rodriguez Valls MJ, Aranda Valera C, de la Iglesia Salgado JL. Association between antinuclear antibodies titers and connective tissue diseases in a Rheumatology Department. Reumatol Clin 2017;13-150-5.
• 16. Gundin S, Irure-Ventura J, Asensio E, Ramos D, Mahler M, Martinez-Taboada V, et al. Measurement of anti-DFS70 antibodies in patients with ANA-associated autoimmune rheumatic diseases suspicion is cost-effective. Auto Immun Highlights 2016;7:10.