Title
Antinuclear Antibody–Negative Systemic Lupus Erythematosus in an International Inception Cohort
Date Issued
01 July 2019
Access level
open access
Resource Type
journal article
Author(s)
Choi M.Y.
Clarke A.E.
St. Pierre Y.
Hanly J.G.
Urowitz M.B.
Romero-Diaz J.
Gordon C.
Bae S.C.
Bernatsky S.
Wallace D.J.
Merrill J.T.
Isenberg D.A.
Rahman A.
Ginzler E.M.
Petri M.
Bruce I.N.
Dooley M.A.
Fortin P.R.
Gladman D.D.
Sanchez-Guerrero J.
Steinsson K.
Ramsey-Goldman R.
Khamashta M.A.
Aranow C.
Manzi S.
Nived O.
Zoma A.A.
van Vollenhoven R.F.
Ramos-Casals M.
Ruiz-Irastorza G.
Lim S.S.
Kalunian K.C.
Inanc M.
Kamen D.L.
Peschken C.A.
Jacobsen S.
Askanase A.
Stoll T.
Buyon J.
Mahler M.
Fritzler M.J.
University of Alabama at Birmingham
Publisher(s)
SAGE Publications Ltd
Abstract
Objective: The spectrum of antinuclear antibodies (ANAs) is changing to include both nuclear staining as well as cytoplasmic and mitotic cell patterns (CMPs) and accordingly a change is occurring in terminology to anticellular antibodies. This study examined the prevalence of indirect immunofluorescence (IIF) anticellular antibody staining using the Systemic Lupus International Collaborating Clinics inception cohort. Methods: Anticellular antibodies were detected by IIF on HEp-2000 substrate using the baseline serum. Three serologic subsets were examined: ANA positive (presence of either nuclear or mixed nuclear/CMP staining), anticellular antibody negative (absence of any intracellular staining), and isolated CMP staining. The odds of being anticellular antibody negative versus ANA or isolated CMP positive was assessed by multivariable analysis. Results: A total of 1,137 patients were included; 1,049 (92.3%) were ANA positive, 71 (6.2%) were anticellular antibody negative, and 17 (1.5%) had an isolated CMP. The isolated CMP–positive group did not differ from the ANA-positive or anticellular antibody–negative groups in clinical, demographic, or serologic features. Patients who were older (odds ratio [OR] 1.02 [95% confidence interval (95% CI) 1.00, 1.04]), of white race/ethnicity (OR 3.53 [95% CI 1.77, 7.03]), or receiving high-dose glucocorticoids at or prior to enrollment (OR 2.39 [95% CI 1.39, 4.12]) were more likely to be anticellular antibody negative. Patients on immunosuppressants (OR 0.35 [95% CI 0.19, 0.64]) or with anti-SSA/Ro 60 (OR 0.41 [95% CI 0.23, 0.74]) or anti–U1 RNP (OR 0.43 [95% CI 0.20, 0.93]) were less likely to be anticellular antibody negative. Conclusion: In newly diagnosed systemic lupus erythematosus, 6.2% of patients were anticellular antibody negative, and 1.5% had an isolated CMP. The prevalence of anticellular antibody–negative systemic lupus erythematosus will likely decrease as emerging nomenclature guidelines recommend that non-nuclear patterns should also be reported as a positive ANA.
Start page
893
End page
902
Volume
71
Issue
7
Language
English
OCDE Knowledge area
Reumatología
Radiología, Medicina nuclear, Imágenes médicas
Scopus EID
2-s2.0-85057395115
PubMed ID
Source
Arthritis Care and Research
ISSN of the container
2151464X
Sponsor(s)
1U54-TR-001353 [formerly 8UL1-TR-000150], UL-1RR-025741, K24-AR-02318, and P60AR064464 [formerly P60-AR-48098]). Dr. Ruiz-阀rastorza’s work was supported by the Department of Education, Universities, and Research of the Basque Government. 1May Y. Choi, MD, Ann E. Clarke, MD, MSc, Marvin J. Fritzler, PhD, MD: University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada; 2Yvan St. Pierre, MSc, Sasha Bernatsky, MD, PhD: McGill University Health Centre, Montreal, Quebec, Canada; 3John G. Hanly, MD: Queen Elizabeth 阃阀 Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada; 4Murray B. Urowitz, MD, Dafna D. Gladman, MD: Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; 5Juanita Romero-Diaz, MD, MS: 阀nstituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; 6Caroline Gordon, MD: University of Birmingham, Birmingham, UK; 7Sang-Cheol Bae, MD, PhD,...
The authors thank Ms. Haiyan Hou and Meifeng Zhang (Mitogen Advanced Diagnostics, University of Calgary) for technical assistance.
The Montreal General Hospital Lupus Clinic is supported by the Singer Family Fund for Lupus Research. The Hopkins Lupus Cohort is supported by the N 阀H (grants AR-043727 and AR-069572). Dr. Hanly’s work was supported by the Canadian 阀nstitutes of Health Research (grant MOP-88526). Dr. Gordon’s work was supported by Lupus UK, Sandwell and West Birmingham Hospitals NHS Trust, and the N 阀HR/Wellcome Trust Clinical Research Facility in Birmingham. Dr. Bae’s work was supported by the Korea Healthcare technology R&D project, Ministry for Health and Welfare (A120404). Dr. 阀senberg’s and Dr. Rahman’s work was supported by the N 阀HR University College London Hospitals Biomedical Research Centre. Dr. Bruce’s work was supported by Arthritis Research UK, the N 阀HR Manchester Biomedical Research Centre, and the N 阀HR/Wellcome Trust Manchester Clinical Research Facility. Dr. Dooley’s work was supported by the N 阀H (grant RR-00046). Dr. Ramsey-Goldman’s work was supported by the N 阀H (grants
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