Anti-Nuclear Antibody (ANA HEP2) (ANF)

Immunology

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Description

ANA are positive in 95-100% of patients with systemic lupus erythematosus ( SLE ), 40-70% of Sjogren's patients and 60-80% of scleroderma patients [1]. A postive ANA can also be present in patients with primary biliary cirrhosis ( PBC ), Raynaud's, rheumatoid arthritis, dermatomyositis, mixed connective tissue disease and other autoimmune conditions. They are however found in low and high titre in many non-autoimmune conditions and are not diagnostic. Homogenous patterns are associated with SLE and mixed connective tissue disease. Speckled patterns are also associated with SLE, Sjogren's, scleroderma, polymyositis, rheumatoid arthritis and mixed connective tissue patterns. Anti-centromere antibody is a marker for the CREST variant of scleroderma. Positive centromere antibodies are also found in primary biliary cirrhosis, of whom half may have features of scleroderma ( progressive systematic sclerosis ) and in other conditions such as primary Raynaud's. Anti-nucleolar antibodies are seen primarily in patients with scleroderma where they are found in high titres and often with overlap features of myositis. This ANA specificity is less frequently encountered in systemic lupus erythematosus ( SLE ), chronic polyarthritis, primary Sjogren's syndrome and Raynaud's phenomenon, where they may be present, generally at low titres. Nucleolar antibodies are not uncommon in patients with non-autoimmune liver disease and other conditions. Anti-Ro antibody is found in Sjogren's syndrome and SLE High titres in pregnancy may be implicated in congenital heart block. Various other antibodies can also be detected including anti-mitochondrial antibodies ( AMA ). AMA occur in PBC and Sjogren's syndrome. Different types of AMA are described, based on antigen specificity, designated on a numerical basis: M1 to M9. The AMA associated with PBC is usually M2a or M2b.

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Indications

High suspicion of systemic autoimmune disease such as: SLE, Sjogren's syndrome, Raynauds, PBC, scleroderma, CREST, dermatomysoitis or polymyositis. Insensitive for Jo-1 associated myositis.

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Sample Type

2mL Serum ( Gel 5mL Yellow tube ). Requests from outside Sheffield: Transport at ambient temperature via Royal Mail or Courier.

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Reference Range

Negative ( at 1 in 100 dilution ).

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Turnaround Time

Within 5 days

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Testing Frequency

Daily

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References

Khan S, et al. The clinical significance of antinucleolar antibodies. J Clin Pathol. 2008. 61:283-286.
Koenig M, Diede M, Senecal JL. Predictive value of antinuclear autoantibodies: the lessons of the systemic sclerosis autoantibodies. Autoimmunity Reviews. 2008. 7: 588-593.
Muro Y. Antinuclear antibodies. Autoimmunity. 2005. 38( 1 ): 3-9.
Kavanagh A, et al. Guidelines for clinical use of antinuclear antibody test and tests for specific autoantibodies to nuclear antigens. American College of Pathologists. Arch Pathol Lab Med. 2000. 124( 1 ):71-81. [Ref 1]
Peene I, et al. Detection and identification of antinuclear antibodies ( ANA ) in a large and consecutive cohort of serum samples referred for ANA testing. Ann Rheum Dis. 2001. 60( 12 ):1131-1136.

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See Also

ENA; dsDNA; crithidia

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