Keywords
Anti ds-DNA
Autoimmunity
SLE
Immune fluorescence
Submitted : 2024-06-18
Accepted : 2024-07-03
Published : 2024-07-18
Abstract
The study was designed to find the prevalence of ANA antibodies and anti-dsDNA antibodies in samples tested at AFIP Rawalpindi and their correlation with age and gender and to find positive and negative predictive values of ANA antibodies. For this purpose, twelve thousand nine hundred sixty-seven (12,967) patients were analyzed for ANA with four hundred sixty-eight (468) healthy samples tested as control and four thousand seven hundred three (4,703) patients tested for ds-DNA antibodies. Retrospective data of all samples tested by indirect immunofluorescence (IIF) for ANA antibodies and dsDNA antibodies was collected. To address positive and negative predictive values another control group (autoimmunity not suspected) of serum samples was taken from the healthy population. For the first group, age, gender, ANA antibodies and ds-DNA antibodies results (both tests performed by IIF) data was collected from a computer record cell; for the second control group, ANA antibodies were performed by IIF. 12,967 and 4,703 samples (Group 1) were tested for ANA antibodies and dsDNA antibodies, respectively, during this period. 1,119 (9%) and 99 (2%) were found positive for ANA antibodies and ds DNA antibodies. Among these positive samples, 850 (76%) and 73 (74%) were females respectively. Gender predisposition towards autoimmunity (ANA) was found significant with a P value of (P = 0.001). Relation of age was also found significant with anti-ANA antibodies with a P value of (P = 0.001). This study shows a negative correlation between age (P = 0.025) and gender (P = 0.001) with anti-dsDNA which is also significant. High prevalence was found below the mean age of 38 years (SD ± 16.635) for ANA antibodies and the mean age of 35 years (SD ± 15.066) for ds-DNA antibodies. The age of ANA antibodies and dsDNA antibodies positive patients ranged from 1 year old to 98 years old and 2 years old to 95 years old respectively. In the second (autoimmunity-free) control group, a total of 468 samples were tested for ANA antibodies and 9 (2%) were found positive. Positive predictive value (PPV) was 8.6% and negative predictive value (NPV) was 98%. ANA is a sensitive test for autoimmunity and it is significantly related to female gender and increasing age. The low prevalence of ANA antibodies among clinically suspected cases suggests that rationalization of test prescriptions is needed. Anti-ds-DNA is also a sensitive test for diagnosis of SLE and it is significantly related to female gender and increasing age.
References
Pisetsky DS, 2023, Pathogenesis of Autoimmune Disease. Nature Reviews Nephrology, 19(8): 509–524.
Anis S, Fatima A, Abdul Jabbar S, et al., 2023, ANA-specific Antibodies, ANA Patterns, Anti-ds-DNA Results, and Clinical Diagnosis: A Laboratory and Clinical Audit. Immunologic Research, 71(2): 267–275.
Xiao Y, Lin Y, Zhang Y, et al., 2022, Factors Associated with the Antinuclear Antibody (ANA) Titer of Systemic Autoimmune Rheumatic Diseases in ANA-positive Patients After Treatment: A Retrospective Study. Clinical and Experimental Medicine, 22(3): 439–446.
Rubio J, Kyttaris VC, 2023, Undifferentiated Connective Tissue Disease: Comprehensive Review. Current Rheumatology Reports, 25(5): 98–106.
Tsoi A, Nikolopoulos D, Parodis I, 2024, Advances in the Pharmacological Management of Systemic Lupus Erythematosus. Expert Opinion on Pharmacotherapy, 25(6): 705–716.
Brito-Zeron P, Retamozo S, Ramos-Casals M, 2023, Sjögren’s Syndrome. Medicina Clinical, 160(4): 163–171.
Hussaini HM, Seo B, Rich AM, 2022, Immunohistochemistry and Immunofluorescence, Oral Biology: Molecular Techniques and Applications, Springer, New York, 439–450.
Abbas Z, Asim M, Saeed A, et al., 2021, The Spectrum of Autoimmune Liver Disorders, Clinical Presentation, and Autoantibodies in Patients from a Tertiary Care Center in Pakistan. Cureus, 13(11): e19789.
Baig S, Paik JJ, 2020, Inflammatory Muscle Disease: An Update. Best Practice & Research Clinical Rheumatology, 34(1): 101484.
Granito A, Muratori L, Tovoli F, et al., 2021, Diagnostic Role of Anti-dsDNA Antibodies: Do Not Forget Autoimmune Hepatitis. Nature Reviews Rheumatology, 17(4): 244.
Zhan M, Wang Z, Bao H, et al., 2023, Antibodies Against Neutrophil Extracellular Traps (NETs) Potentiate Clinical Performance of Anti-double-stranded DNA Antibodies in Systemic Lupus Erythematosus. Clinical Immunology, 2023(249): 109297.
He S, Wu X, Li L, et al., 2023, A Comparison of the Chemiluminescence Immunoassay and Crithidia luciliae Immunofluorescence Test in Detecting Anti-dsDNA Antibodies and Assessing the Activity of Systemic Lupus Erythematosus. Lupus, 32(8): 936–941.
De Oliveira NT, Silva NG, Dos Santos TAG, et al., 2020, Clinical and Autoantibody Profile in Male and Female Patients with Systemic Lupus Erythematosus: A Retrospective Study in 603 Brazilian Patients. European Journal of Rheumatology, 7(4): 164.
Tsouris Z, Liaskos C, Dardiotis E, et al., 2020, A Comprehensive Analysis of Antigen-specific Autoimmune Liver Disease-related Autoantibodies in Patients with Multiple Sclerosis. Autoimmunity Highlights, 2020(11): 1–8.
Yoo H, Hino T, Hwang J, et al., 2022, Connective Tissue Disease-related Interstitial Lung Disease (CTD-ILD) and Interstitial Lung Abnormality (ILA): Evolving Concept of CT Findings, Pathology and Management. European Journal of Radiology Open, 2022(9): 100419.
Janczyk W, Bierla JB, Trojanowska I, et al., 2023, Prevalence and Significance of Autoantibody Seropositivity in Children with Wilson’s Disease. Diagnostics, 13(4): 768.
Yeo AL, Kandane-Rathnayake R, Koelmeyer R, et al., 2024, SMART-SLE: Serology Monitoring and Repeat Testing in Systemic Lupus Erythematosus: An Analysis of Anti-double-stranded DNA Monitoring. Rheumatology, 63(2): 525–533.
Dillon CF, Weisman MH, Miller FW, 2020, Population-based Estimates of Humoral Autoimmunity from the US National Health and Nutrition Examination Surveys (1960–2014). PLoS One, 15(1): e0226516.
Hasan SS, Shaikh A, Ochani RK, et al., 2021, Perception and Practices Regarding Cannabis Consumption in Karachi, Pakistan: A Cross-Sectional Study. Journal of Ethnicity in Substance Abuse, 20(3): 471–489.
Latif S, Saeed M, 2023, Hematological and Inflammatory Parameters in Hookah Smokers and Nonsmokers: A Cross-sectional Study. Journal of University College of Medicine and Dentistry, 2(1): 26–30.
Deng X, Sun S, Yao W, et al., 2024, The Association between Three Prevalent Autoimmune Disorders and the Likelihood of Developinge Prostate Cancer: A Mendelian Randomization Study. Scientific Reports, 14(1): 11755.