Citation Information :
Basu I, Gupta S, Mukherjee A, Bedi M, Sengupta S, Panda B. Retrospective Assessment of Antinuclear Antibody by Indirect Immunofluorescence Microscopy and Immunoblot in Patients with Polyarthritis. Indian J Med Biochem 2022; 26 (3):77-80.
Introduction: Detection of antinuclear antibody (ANA) by immunofluorescence assay (IFA) is the method of choice for screening autoimmune polyarthritis, where the different patterns are etched in the cellular components as per the group of antibodies present in the patient. Like all other screening tests, it has its sensitivity and specificity, and the final confirmation is done by doing a multispot immunoblot testing, where the specific antibodies against a specific antigen is detected.
Aims and objectives: The study aimed at finding out the sensitivity and specificity of IFA with respect to immunoblot assay and to detect whether any pattern can be detected to attribute to false-positive and false-negative cases.
Materials and methods: The conducted study is a retrospective analysis of 100 reports available from the Laboratory Information System. Patients referred by rheumatologists with clinical polyarthritis prescribed for both ANA by IFA and immunoblot are taken for the study. Sensitivity and specificity of ANA by IFA is calculated taking immunoblot as confirmatory gold standard.
Results: The sensitivity and specificity were calculated as 80 and 84.3%, respectively, in polyarthritis cases and anticell (AC)-1 and AC-4 were implicated in most of the false-positive and false-negative cases.
Conclusion: Antinuclear antibody by IFA needs confirmation by immunoblot for antibody profile characterization. AC-1 and AC-4 if detected on IFA mandates for immunoblot as most of the false positives and negatives are implicated with these patterns.
Hudson M, Bernatsky S, Colmegna I, et al. Novel insights into systemic autoimmune rheumatic diseases using shared molecular signatures and an integrative analysis. Epigenetics 2017;12(6):433–440. DOI: 10.1080/15592294.2017.1303581.
Helmick CG, Felson DT, Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum 2008;58(1):15–25. DOI: 10.1002/art.23177.
Jacobson DL, Gange SJ, Rose NR, et al. Epidemiology and estimated population burden of selected autoimmune diseases in the United States. Clin Immunol Immunopathol 1997;84(3):223–243. DOI: 10.1006/clin.1997.4412.
Greer JM, McCombe PA. The role of epigenetic mechanisms and processes in autoimmune disorders. Biologics 2012;6:307–327. DOI: 10.2147/BTT.S24067.
Giacomelli R, Afeltra A, Alunno A, et al. Guidelines for biomarkers inautoimmune rheumatic diseases evidence-based analysis. Autoimmun Rev 2019;18(1):93–106. DOI: 10.1016/j.autrev.2018.08.003.
Pisetsky DS. Antinuclear antibody testing - Misunderstood or misbegotten? Nat Rev Rheumatol 2017;13(8):495–502. DOI: 10.1038/nrrheum.2017.74.
Agmon-Levin N, Damoiseaux J, Kallenberg C, et al. International recommendations for the assessment of autoantibodies to cellular antigens referred to as antinuclear antibodies. Ann Rheum Dis 2014;73(1):17–23. DOI: 10.1136/annrheumdis-2013-203863.
Damoiseaux J, von Mühlen CA, Garcia-De La Torre I, et al. International consensus on ANA patterns (ICAP): the bumpy road towards a consensus on reporting ANA results. Auto Immun Highlight 2016; 7(1):1. DOI: 10.1007/s13317-016-0075-0.
Hoffman IE, Peene I, Veys EM, et al. Detection of specific antinuclear reactivities in patients with negative antinuclear antibody immunofluorescence screening tests. Clin Chem 2002;48(12): 2171–2176.
Tan EM, Smolen JS, MacDougal JS, et al. A critical evaluation of enzyme immunoassays for detection of antinuclear antibodies of defined specificities. Arthritis Rheum 1999;42(3):455–464. DOI: 10.1002/1529-0131(199904)42:3<455::AID-ANR10>3.0.CO;2-3.
Moncé NH, Bogusky RT, Cappel NN. An enzyme immunoassay screening test for the detection of total antinuclear antibodies. J Clin Lab Anal 1991;5(6):439–442. DOI: 10.1002/jcla.1860050612.
Smith-Bouvier DL, Divekar AA, Sasidhar M, et al. A role for sex chromosome complement in the female bias in autoimmune disease. J Exp Med 2008;205(5):1099–1108. DOI: 10.1084/jem.20070850.
Carrel L, Willard HF. X-inactivation profile reveals extensive variability in X-linked gene expression in females. Nature 2005;434(7031): 400–404. DOI: 10.1038/nature03479.
Willard HF. Tales of the Y chromosome. Nature 2003;423(6942): 811–813. DOI: 10.1038/423810a.
Schurz H, Salie M, Tromp G, et al. The X chromosome and sex specific effects in infectious disease susceptibility. Hum Genomics 2019;13(1):2. DOI: 10.1186/s40246-018-0185-z.
Angum F, Khan T, Kaler J, et al. The prevalence of autoimmune disorders in women: A narrative review. Cureus 2020;12(5):e8094.
Peschken CA, Robinson DB, Hitchon CA, et al. Pregnancy and the risk of rheumatoid arthritis in a highly predisposed North American native population. J Rheumatol 2012;39(12):2253–2260. DOI: 10.3899/jrheum.120269.