title: Anti-nuclear antibodies in daily clinical practice: prevalence in primary, secondary, and tertiary care.
abstract: For the diagnosis of systemic autoimmune rheumatic diseases (SARD), patients are screened for anti-nuclear antibodies (ANA). ANA, as assessed by indirect immunofluorescence (IIF), have a poor specificity. This hampers interpretation of positive results in clinical settings with low pretest probability of SARD. We hypothesized that the utility of positive ANA IIF results increases from primary to tertiary care. We retrospectively determined ANA, anti-ENA, and anti-dsDNA antibody prevalence in patient cohorts from primary (n = 1453), secondary (n = 1621), and tertiary (n = 1168) care settings. Results reveal that from primary care to tertiary care, ANA prevalence increases (6.2, 10.8, and 16.0%, resp.). Moreover, in primary care low titres (70% versus 51% and 52% in secondary and tertiary care, resp.) are more frequent and anti-ENA/dsDNA reactivities are less prevalent (21% versus 39% in secondary care). Typically, in tertiary care the prevalence of anti-ENA/dsDNA reactivities (21%) is lower than expected. From this descriptive study we conclude that positive ANA IIF results are more prone to false interpretation in clinical settings with low pretest probabilities for SARD, as in primary care. Whether alternative approaches, that is, immunoadsorption of anti-DFS70 antibodies or implementation of anti-ENA screen assays, perform better, needs to be determined.
authors.affiliation: Central Diagnostic Laboratory, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
authors.forename: Thomas Y
authors.initials: TY
authors.lastname: Avery
authors.affiliation: Department of Microbiology, Atrium Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.
authors.forename: Mart
authors.initials: M
authors.lastname: van de Cruys
authors.affiliation: Central Diagnostic Laboratory, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: Austen
authors.affiliation: Department of Microbiology, Atrium Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.
authors.forename: Frans
authors.initials: F
authors.lastname: Stals
authors.affiliation: Central Diagnostic Laboratory, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
authors.forename: Jan G M C
authors.initials: JG
authors.lastname: Damoiseaux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000974:Antibodies, Antinuclear / Q000097:blood*; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005455:Fluorescent Antibody Technique / Q000379:methods; D019084:Fluorescent Antibody Technique, Indirect / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000453:epidemiology*; D063127:Secondary Health Care / Q000706:statistics & numerical data*; D016036:Seroepidemiologic Studies; D063128:Tertiary Health Care / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000974:Antibodies, Antinuclear; C033055:anti-extractable nuclear antigen antibodies
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