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Antinuclear Antibody–Negative Systemic Lupus Erythematosus in an International Inception Cohort
Author(s) -
Choi May Y.,
Clarke Ann E.,
St. Pierre Yvan,
Hanly John G.,
Urowitz Murray B.,
RomeroDiaz Juanita,
Gordon Caroline,
Bae SangCheol,
Bernatsky Sasha,
Wallace Daniel J.,
Merrill Joan T.,
Isenberg David A.,
Rahman Anisur,
Ginzler Ellen M.,
Petri Michelle,
Bruce Ian N.,
Dooley Mary A.,
Fortin Paul R.,
Gladman Dafna D.,
SanchezGuerrero Jorge,
Steinsson Kristjan,
RamseyGoldman Rosalind,
Khamashta Munther A.,
Aranow Cynthia,
Alarcón Graciela S.,
Manzi Susan,
Nived Ola,
Zoma Asad A.,
Vollenhoven Ronald F.,
RamosCasals Manuel,
RuizIrastorza Guillermo,
Lim S. Sam,
Kalunian Kenneth C.,
Inanc Murat,
Kamen Diane L.,
Peschken Christine A.,
Jacobsen Soren,
Askanase Anca,
Stoll Thomas,
Buyon Jill,
Mahler Michael,
Fritzler Marvin J.
Publication year - 2019
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23712
Subject(s) - anti nuclear antibody , medicine , iif , antibody , staining , serology , anti dsdna antibodies , odds ratio , confidence interval , immunology , autoantibody , pathology
Objective The spectrum of antinuclear antibodies ( ANA s) is changing to include both nuclear staining as well as cytoplasmic and mitotic cell patterns ( CMP s) 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 HE p‐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 .