title: Accuracy of anti-ribosomal P protein antibody testing for the diagnosis of neuropsychiatric systemic lupus erythematosus: an international meta-analysis.
abstract: OBJECTIVE
  To quantitatively evaluate the diagnostic accuracy of antibodies to ribosomal P proteins (anti-P) for neuropsychiatric systemic lupus erythematosus (NPSLE) in general, for psychosis, mood disorder, or both, and for other diffuse manifestations.
  
  
  METHODS
  This international meta-analysis combined standardized data from 1,537 lupus patients contributed by 14 research teams. Weighted estimation of sensitivity and specificity with fixed-effects and random-effects models, as well as summary receiver operating characteristic (SROC) curve analysis, was used to summarize test performance. The robustness of the overall estimates was examined in sensitivity analyses that included additional studies published up to November 1, 2004 in the Medline, EMBase, and Cochrane databases.
  
  
  RESULTS
  Combining the data from the 14 teams, the weighted sensitivity and specificity estimates for the diagnosis of NPSLE were 26% (95% confidence interval [95% CI] 15-42%) and 80% (95% CI 74-85%), respectively. For psychosis, mood disorder, or both, the sensitivity and specificity were 27% (95% CI 14-47%) and 80% (95% CI 74-85%), respectively. For other diffuse manifestations, the sensitivity was 24% (95% CI 12-42%), and the specificity was 80% (95% CI 73-85%). The proportion of patients with anti-P antibodies did not vary markedly across different presentations of NPSLE. Between-study heterogeneity was substantial, but the SROC curves were consistent with the weighted estimates. In further analyses that included another 24 published studies, only the sensitivity for psychosis and/or mood disorder was slightly improved, but it was still suboptimal (42% [95% CI 30-53%]); the specificity remained essentially the same (81% [95% CI 76-85%]).
  
  
  CONCLUSIONS
  Anti-P antibody testing has limited diagnostic value for NPSLE, and it is not helpful in differentiating among various disease phenotypes.
authors.affiliation: Dept. of Hygiene and Epidemiology, University of Ioannina School of Medicine, 45110 Ioannina, Greece.
authors.forename: Fotini B
authors.initials: FB
authors.lastname: Karassa
authors.forename: Antonella
authors.initials: A
authors.lastname: Afeltra
authors.forename: Ales
authors.initials: A
authors.lastname: Ambrozic
authors.forename: Deh-Ming
authors.initials: DM
authors.lastname: Chang
authors.forename: Filip
authors.initials: F
authors.lastname: De Keyser
authors.forename: Andrea
authors.initials: A
authors.lastname: Doria
authors.forename: Mauro
authors.initials: M
authors.lastname: Galeazzi
authors.forename: Shunsei
authors.initials: S
authors.lastname: Hirohata
authors.forename: Ilse E A
authors.initials: IE
authors.lastname: Hoffman
authors.forename: Murat
authors.initials: M
authors.lastname: Inanc
authors.forename: Loreto
authors.initials: L
authors.lastname: Massardo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mathieu
authors.forename: Chi Chiu
authors.initials: CC
authors.lastname: Mok
authors.forename: Gabriella
authors.initials: G
authors.lastname: Morozzi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sanna
authors.forename: Alberto J
authors.initials: AJ
authors.lastname: Spindler
authors.forename: Athanasios G
authors.initials: AG
authors.lastname: Tzioufas
authors.forename: Taku
authors.initials: T
authors.lastname: Yoshio
authors.forename: John P A
authors.initials: JP
authors.lastname: Ioannidis
mesh_terms: D000906:Antibodies / Q000097:blood*; D006801:Humans; D020945:Lupus Vasculitis, Central Nervous System / Q000097:blood* / Q000175:diagnosis*; D015203:Reproducibility of Results; D012269:Ribosomal Proteins / Q000276:immunology*; D012680:Sensitivity and Specificity
chemical_list: D000906:Antibodies; D012269:Ribosomal Proteins