Background

Indirect immunofluorescence (IIF) is the most prevalent screening antinuclear antibody test for systemic autoimmune rheumatic disease (SARD). Certain IIF patterns have known antibody and disease associations, but the dense fine speckled (ANA-DFS) pattern has no confirmed clinical associations. Our objective was to determine the prevalence of SARD among a group of ANA-DFS positive individuals and to identify final diagnoses among non-SARD individuals in order to determine possible clinical associations with the ANA-DFS pattern.

Methods

A retrospective study of 425 patients from a university health care system with a positive ANA-DFS pattern consecutively between August 2017 and September 2018. Sera samples underwent ANA testing by IIF on HEp-2 cell substrates (Euroimmun, Germany). Clinical information was retrieved from electronic health records and stored in a de-identified database.

Results

The prevalence of SARD was 24%. Undetermined diagnosis (17%), skin disorders (12.1%), and fibromyalgia/chronic pain syndrome/chronic fatigue syndrome (11.8%) were the most common non-SARD diagnoses. Taking into account past medical history, the most common non-SARD were atopic disorders (21.2%), fibromyalgia/chronic pain syndrome/chronic fatigue syndrome (17.6%), and skin disorders (16.7%).

Conclusions

The ANA-DFS pattern may be indicative of an underlying antigen-antibody interaction that plays a role in either the initiation or propagation of immunologic reactions. DFS70/LEDGF is a transcription factor involved in cell survival and stress protection, and autoantibodies may inhibit its function. It is likely that there are other antibodies producing the ANA-DFS pattern besides anti-DFS70/LEDGF, and more research is necessary to identify additional antibody specificities. The ANA-DFS pattern may be an indicator of a proinflammatory microenvironment given the high frequency of symptomatic patients and disease processes with an immunologic basis (including SARD).

中文翻译：

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抗核抗体密集的斑点状图案和可能的临床关联：促炎性微环境的迹象

背景

间接免疫荧光（IIF）是针对系统性自身免疫性风湿性疾病（SARD）的最普遍的筛查抗核抗体测试。某些IIF模式具有已知的抗体和疾病关联，但是密集的斑点（ANA-DFS）模式没有确定的临床关联。我们的目标是确定一组ANA-DFS阳性个体中SARD的患病率，并确定非SARD个体中的最终诊断，以便确定与ANA-DFS模式可能的临床关联。

方法

一项回顾性研究对2017年8月至2018年9月期间来自大学医疗系统的ANA-DFS模式呈阳性的425名患者进行了回顾性研究。血清样品通过IIF在HEp-2细胞底物上进行了ANA测试（德国Euroimmun）。从电子健康记录中检索出临床信息，并将其存储在一个未识别的数据库中。

结果

SARD的患病率为24％。不确定性诊断（17％），皮肤疾病（12.1％）和纤维肌痛/慢性疼痛综合征/慢性疲劳综合征（11.8％）是最常见的非SARD诊断。考虑到过去的病史，最常见的非SARD为特应性疾病（21.2％），纤维肌痛/慢性疼痛综合征/慢性疲劳综合征（17.6％）和皮肤疾病（16.7％）。

结论

ANA-DFS模式可以指示潜在的抗原-抗体相互作用，该相互作用在免疫反应的引发或传播中起作用。DFS70 / LEDGF是参与细胞存活和应激保护的转录因子，自身抗体可能会抑制其功能。除抗DFS70 / LEDGF外，可能还有其他抗体会产生ANA-DFS模式，因此有必要开展更多研究来鉴定其他抗体特异性。鉴于有症状的患者和具有免疫学基础（包括SARD）的疾病过程的高频率，ANA-DFS模式可能是促炎性微环境的指标。