An italian multicenter study for application of a diagnostic algorithm in autoantibody testing.
The presence in the serum of specific autoantibodies, such as antinuclear antibodies (ANA), anti-double-stranded DNA (anti-dsDNA), and antiextractable nuclear antigens (anti-ENA), is one of the diagnostic criteria for autoimmune rheumatic disease, and the requests for these tests in the last few years have grown remarkably. A guideline for reducing clinically inappropriate requests in autoantibody testing (ANA, anti-dsDNA, anti-ENA) has been applied in the Parma Hospital since 2007. The results for the period January-December 2007 were compared to those of the previous period January-December 2006, and a significant reduction in the number of anti-dsDNA (23.9%) and anti-ENA (20.7%) was found. The aim of this study was to assess the applicability of a similar guideline in a wide area (Parma, Modena, Piacenza, Reggio-Emilia) with reference to the diagnosis of autoimmune rheumatic disease. This project, supported by a regional grant for innovative research projects, was started in January 2008 and consists of three different steps: (1) a study group of clinicians and laboratory physicians to evaluate the diagnostic criteria, the analytical procedures, and the number of tests performed in different hospitals; (2) developing common guidelines for autoantibody testing that takes into account the different clinical needs with the aim of improving efficiency and clinical effectiveness of diagnosis and monitoring; and (3) assessing compliance with the guidelines in the different hospitals that are evaluating the second-level test (anti-dsDNA, anti-ENA) decrease. We think that the validation of guidelines for the laboratory diagnosis of autoimmune rheumatic disease can represent a tool for improving patients' outcomes and economic efficiency.
Bonaguri
Chiara
C
Diagnostic Laboratory Department, Parma Hospital, Parma, Italy. cbonaguri@ao.pr.it
Melegari
Alessandra
A
Dall'Aglio
PierPaolo
P
Ballabio
Andrea
A
Terenziani
Paolo
P
Russo
Annalisa
A
Battistelli
Luisita
L
Aloe
Rosalia
R
Camisa
Roberta
R
Campaniello
Giovanna
G
Sartori
Elisabetta
E
Monica
Cesare
C
D000465:Algorithms; D000974:Antibodies, Antinuclear / Q000032:analysis; D001323:Autoantibodies / Q000032:analysis*; D001327:Autoimmune Diseases / Q000175:diagnosis*; D045744:Cell Line, Tumor; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D019084:Fluorescent Antibody Technique, Indirect; D017408:Guidelines as Topic / Q000592:standards; D006801:Humans; D015151:Immunoblotting / Q000379:methods; D007124:Immunoenzyme Techniques / Q000379:methods; D007558:Italy; D012015:Reference Standards; D015203:Reproducibility of Results; D012216:Rheumatic Diseases / Q000175:diagnosis*; D012680:Sensitivity and Specificity
D000974:Antibodies, Antinuclear; D001323:Autoantibodies; C035356:SS-A antibodies; C035357:SS-B antibodies