Not positive about antinuclear antibody–negative lupus: comment on the article by Choi et al

Abeles, Aryeh M.

doi:10.1002/acr.24158

Cited by 3 publications

(1 citation statement)

References 6 publications

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“…An international inception cohort study by Choi et al[ 13 ] showed that, in 1,132 patients enrolled in the group, 6.2% were anti-cellular antibody negative, which is much higher than that of the other cohorts study. However, as the comments on the article by Abeles,[ 14 ] 46% of ANA-negative patients in the cohort received high-dose glucocorticoids prior to enrollment. Previous studies have shown that ANA negativity occurs in patients with established SLE.…”

Section: Discussionmentioning

confidence: 99%

Antinuclear antibody-negative systemic lupus erythematosus: How many patients and how to identify?

Zheng

Chen

et al. 2022

Arch Rheumatol

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Objectives: This study aims to the prevalence of antinuclear antibody (ANA)-negative systemic lupus erythematosus (SLE) and their clinical characteristics in a large single-center SLE inception cohort to provide guidance for early diagnosis. Patients and methods: Between December 2012 and March 2021, the medical records of a total of 617 firstly diagnosed SLE patients (83 males, 534 females; median age [IQR]: 33+22.46 years) who fulfilled the selection criteria were retrospectively analyzed. The patients were divided into groups with ANA-negative SLE and ANA-positive SLE, or with prolonged use of glucocorticoids or immunosuppressants (SLE-1) and without (SLE-0). Demographic, clinical characteristics, and laboratory features were collected. Results: The total prevalence of ANA-negative SLE patients was 2.11% (13/617). The prevalence of ANA-negative SLE in SLE-1 (7.46%) was significantly higher than that in SLE-0 (1.48%) (p<0.01). The ANA-negative SLE patients had a higher prevalence of thrombocytopenia (84.62%) than ANA-positive SLE patients (34.27%). As with ANA-positive SLE, ANA-negative SLE also had a high prevalence of low complement (92.31%) and anti-double-stranded deoxyribonucleic acid (anti-dsDNA) positivity (69.23%). The prevalence of medium-high titer anti-cardiolipin antibody (aCL) IgG (50.00%) and anti-ß2 glycoprotein I (anti-ß2GPI) (50.00%) of ANA-negative SLE was significantly higher than that of ANA-positive SLE (11.22% and 14.93%, respectively). Conclusion: The prevalence of ANA-negative SLE is very low, but it exists, particularly under the influence of prolonged use of glucocorticoids or immunosuppressants. Thrombocytopenia, low complement, positive anti-dsDNA, and medium-high titer antiphospholipid antibody (aPL) are the main manifestations of ANA-negative SLE. It is necessary to identify complement, anti-dsDNA, and aPL in ANA-negative patients with rheumatic symptoms, particularly thrombocytopenia.

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Section: Discussionmentioning

confidence: 99%

Antinuclear antibody-negative systemic lupus erythematosus: How many patients and how to identify?

Zheng

Chen

et al. 2022

Arch Rheumatol

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Acute encephalitis in primary Sjögren’s syndrome: A case report and literature review

Higashida-Konishi

Akiyama

Shimada

et al. 2021

Modern Rheumatology Case Reports

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Acute encephalitis is an extremely rare condition in primary Sjogren’s syndrome (pSS), and its characteristics and prognosis remain unclear. Here, we report the case of pSS presented with acute encephalitis. She was admitted to our hospital for acute disturbance of consciousness. Acute encephalitis was diagnosed based on the results of the cerebrospinal fluid test (the increase of leucocyte counts, proteins, and interleukin-6 levels), magnetic resonance imaging, and single-photon emission computed tomography with 99mTc. The infectious aetiologies and underlying malignancies were excluded. Serum anti-Sjogren’s syndrome-related antigen A autoantibody was positive with extremely high titre. The biopsy specimen of her labial salivary gland revealed a focal lymphocytic sialadenitis with a score of grade 4 in the Greenspan grade. She also developed diffuse alveolar haemorrhage during the clinical course. She was diagnosed with pSS complicated with acute encephalitis followed by diffuse alveolar haemorrhage and successfully treated with pulse steroids, high dose of prednisolone and intravenous cyclophosphamide. Our present case and literature review suggest that acute encephalitis associated with pSS can be treatable with the immunosuppressive therapy, and thus early recognition and treatment initiation are important for this life-threatening condition. Thus, pSS should be included in the differential diagnosis of unexplained encephalitis. Notably, our case characteristically showed diffuse alveolar haemorrhage, adding new insights into the pathogenesis of acute encephalitis associated with pSS that capillaritis might be the underlying cause of this condition.

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Antinuclear Antibody-Negative Systemic Lupus Erythematosus

Muralidharan

Rao

2023

Clinical Dermatology Review

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Systemic lupus erythematosus (SLE) is an autoimmune connective disorder characterized by the presence of autoantibodies. Indirect immunofluorescence is considered as the gold standard for the detection of antinuclear antibodies (ANA). False-negative ANA results have resulted in misclassification of some patients as ANA-negative SLE. There are many possible explanations for this negative ANA status of SLE patients. Current evidence in literature suggests that ANA-negative lupus is a questionable entity.

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Not positive about antinuclear antibody–negative lupus: comment on the article by Choi et al

Cited by 3 publications

References 6 publications

Antinuclear antibody-negative systemic lupus erythematosus: How many patients and how to identify?

Antinuclear antibody-negative systemic lupus erythematosus: How many patients and how to identify?

Acute encephalitis in primary Sjögren’s syndrome: A case report and literature review

Antinuclear Antibody-Negative Systemic Lupus Erythematosus

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