Guidelines for the Laboratory Use of Autoantibody Tests in the Diagnosis and Monitoring of Autoimmune Rheumatic Diseases

Tozzoli, Renato; Bizzaro, Nicola; Tonutti, Elio; Villalta, Danilo; Bassetti, D; Manoni, Fabio; Piazza, Antida; Pradella, Marco; Rizzotti, Paolo

doi:10.1309/y5vf-c3dm-l8xv-u053

Cited by 177 publications

(115 citation statements)

References 40 publications

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“…The high specificity of these tests means that they should only be ordered in ANA positive patients with clinical features suggestive of a particular CTD and in ANA negative patients with known or suspected CTD (table 2). 2 These tests are intended for diagnostic confirmation but do not exclude a specific CTD. 1 These antibodies in general do not correlate with disease activity and, therefore, may be found in patients without active disease.…”

Section: Appropriate Use Of Extractable Nuclear Antibodiesmentioning

confidence: 99%

“…ANA are reported in titers with values of at least 1:160 having possible clinical significance and warranting further diagnostic evaluation. 2 ANA titers do not correlate with disease activity and the practice of ordering this test to monitor the course of SLE should be abandoned. 2 In fact, the history and clinical examination, supported in some cases by determination of an estimated sedimentation rate, anti-double stranded DNA (dsDNA) antibody titer and complement levels, better correlate with disease activity and serves to guide treatment decisions.…”

mentioning

confidence: 99%

“…Anti-dsDNA has been shown in some SLE patients to correlate with greater severity of renal involvement and, as noted, is a marker of disease activity. [2][3][4] Elevated levels of anti-nucleosome antibodies have also been shown to be associated with renal involvement and are useful in assessing disease activity, particularly in anti-dsDNA negative patients. 5 Absence of these antibodies in a patient with a high probability of SLE does not rule out the disease (low negative predictive value).…”

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confidence: 99%

See 2 more Smart Citations

Serologic Testing in Connective Tissue Diseases

Habash-Bseiso¹,

Yale²,

Glurich³

et al. 2005

Clinical Medicine & Research

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Section: Appropriate Use Of Extractable Nuclear Antibodiesmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Serologic Testing in Connective Tissue Diseases

Habash-Bseiso¹,

Yale²,

Glurich³

et al. 2005

Clinical Medicine & Research

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“…Five items were selected to advance for literature review. Other items included rheumatoid factor, antineutrophil cytoplasmic antibodies, anticyclic citrullinated peptide antibodies, extractable nuclear antigen (ENA) testing, radiographs, magnetic resonance imaging (MRI) tests, and nonsteroidal 12 , and the Italian Society of Laboratory Medicine Guidelines 13 .…”

Section: Resultsmentioning

confidence: 99%

“…This titer is often used as clinically significant. Thus, to increase its specificity, ANA reports should include the highest titer for which immunofluorescence is detected and include a description of the percentage of patients without any CTD who have similar titers 12,13 .…”

Section: Resultsmentioning

confidence: 99%

Choosing Wisely: The Canadian Rheumatology Association’s List of 5 Items Physicians and Patients Should Question

Sl¹,

J²,

Mj³

et al. 2015

J Rheumatol

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Objective.To develop a list of 5 tests or treatments used in rheumatology that have evidence indicating that they may be unnecessary and thus should be reevaluated by rheumatology healthcare providers and patients.Methods.Using the Delphi method, a committee of 16 rheumatologists from across Canada and an allied health professional generated a list of tests, procedures, or treatments in rheumatology that may be unnecessary, nonspecific, or insensitive. Items with high content agreement and perceived relevance advanced to a survey of Canadian Rheumatology Association (CRA) members. CRA members ranked these top items based on content agreement, effect, and item ranking. A methodology subcommittee discussed the items in light of their relevance to rheumatology, potential effect on patients, and the member survey results. Five candidate items selected were then subjected to a literature review. A group of patient collaborators with rheumatic diseases also reviewed these items.Results.Sixty-four unique items were proposed and after 3 Delphi rounds, this list was narrowed down to 13 items. In the member-wide survey, 172 rheumatologists responded (36% of those contacted). The respondent characteristics were similar to the membership at large in terms of sex and geographical distribution. Five topics (antinuclear antibodies testing, HLA-B27 testing, bone density testing, bone scans, and bisphosphonate use) with high ratings on agreement and effect were chosen for literature review.Conclusion.The list of 5 items has identified starting points to promote discussion about practices that should be questioned to assist rheumatology healthcare providers in delivering high-quality care.

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Autoimmune Disease: Diagnosis

Dey

Isenberg

2012

Encyclopedia of Life Sciences

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The diagnosis of autoimmune diseases invariably requires the detection of autoantibodies, in association with suggestive clinical symptoms, which develop in relation to the involvement of specific or nonspecific organ systems. Many autoantibodies have well‐defined target antigens and can be detected with high analytical sensitivity. Autoantibodies act as biomarkers helping to diagnose disease subsets and monitor autoimmune diseases. The indirect immunoflorescence technique remains the hallmark of diagnosis, but is increasingly being replaced by enzyme immunoassays or multiplexed assays. Comprehensive methods of analysing multiple antibodies simultaneously using multiplex assays are being developed for routine use in the diagnosis, study of the specificity and pathophysiology of autoimmune diseases and the development of antigen specific therapies. Clinical proteomics offers the opportunity to identify new disease biomarkers to help in diagnosing and managing autoimmune diseases. Key Concepts: The diagnosis of autoimmune diseases depends on clinical suspicion and supportive immunological tests. Test for autoantibodies only when there is a clinical suspicion of autoimmune disease as weakly positive ANAs may be present in the normal healthy population. Autoantibodies can be used in diagnosis, monitoring of disease flares and remission, sub‐setting disease, evaluating severity and prognosis. The indirect immunoflorescence technique remains the hallmark of diagnosis, but is increasingly being replaced by enzyme immunoassays or multiplexed assays. Multiplexed immunoassays support the identification of multiple autoantibodies from a single determination simultaneously without having to do follow up testing. Multiplex assays are advantageous as a single test may be used for both screening and determining antibodies of clinical significance. Clinical proteomics offers the opportunity to identify new disease biomarkers in body fluids, cells and tissues to help diagnose diseases.

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Guidelines for the Laboratory Use of Autoantibody Tests in the Diagnosis and Monitoring of Autoimmune Rheumatic Diseases

Cited by 177 publications

References 40 publications

Serologic Testing in Connective Tissue Diseases

Serologic Testing in Connective Tissue Diseases

Choosing Wisely: The Canadian Rheumatology Association’s List of 5 Items Physicians and Patients Should Question

Autoimmune Disease: Diagnosis

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