TY - JOUR
T1 - Antinuclear Antibody–Negative Systemic Lupus Erythematosus in an International Inception Cohort
AU - Choi, May Y.
AU - Clarke, Ann E.
AU - St. Pierre, Yvan
AU - Hanly, John G.
AU - Urowitz, Murray B.
AU - Romero-Diaz, Juanita
AU - Gordon, Caroline
AU - Bae, Sang Cheol
AU - Bernatsky, Sasha
AU - Wallace, Daniel J.
AU - Merrill, Joan T.
AU - Isenberg, David A.
AU - Rahman, Anisur
AU - Ginzler, Ellen M.
AU - Petri, Michelle
AU - Bruce, Ian N.
AU - Dooley, Mary A.
AU - Fortin, Paul R.
AU - Gladman, Dafna D.
AU - Sanchez-Guerrero, Jorge
AU - Steinsson, Kristjan
AU - Ramsey-Goldman, Rosalind
AU - Khamashta, Munther A.
AU - Aranow, Cynthia
AU - Alarcón, Graciela S.
AU - Manzi, Susan
AU - Nived, Ola
AU - Zoma, Asad A.
AU - van Vollenhoven, Ronald F.
AU - Ramos-Casals, Manuel
AU - Ruiz-Irastorza, Guillermo
AU - Lim, S. Sam
AU - Kalunian, Kenneth C.
AU - Inanc, Murat
AU - Kamen, Diane L.
AU - Peschken, Christine A.
AU - Jacobsen, Soren
AU - Askanase, Anca
AU - Stoll, Thomas
AU - Buyon, Jill
AU - Mahler, Michael
AU - Fritzler, Marvin J.
N1 - Publisher Copyright:
© 2018, American College of Rheumatology
PY - 2019/7
Y1 - 2019/7
N2 - Objective: The spectrum of antinuclear antibodies (ANAs) is changing to include both nuclear staining as well as cytoplasmic and mitotic cell patterns (CMPs) and accordingly a change is occurring in terminology to anticellular antibodies. This study examined the prevalence of indirect immunofluorescence (IIF) anticellular antibody staining using the Systemic Lupus International Collaborating Clinics inception cohort. Methods: Anticellular antibodies were detected by IIF on HEp-2000 substrate using the baseline serum. Three serologic subsets were examined: ANA positive (presence of either nuclear or mixed nuclear/CMP staining), anticellular antibody negative (absence of any intracellular staining), and isolated CMP staining. The odds of being anticellular antibody negative versus ANA or isolated CMP positive was assessed by multivariable analysis. Results: A total of 1,137 patients were included; 1,049 (92.3%) were ANA positive, 71 (6.2%) were anticellular antibody negative, and 17 (1.5%) had an isolated CMP. The isolated CMP–positive group did not differ from the ANA-positive or anticellular antibody–negative groups in clinical, demographic, or serologic features. Patients who were older (odds ratio [OR] 1.02 [95% confidence interval (95% CI) 1.00, 1.04]), of white race/ethnicity (OR 3.53 [95% CI 1.77, 7.03]), or receiving high-dose glucocorticoids at or prior to enrollment (OR 2.39 [95% CI 1.39, 4.12]) were more likely to be anticellular antibody negative. Patients on immunosuppressants (OR 0.35 [95% CI 0.19, 0.64]) or with anti-SSA/Ro 60 (OR 0.41 [95% CI 0.23, 0.74]) or anti–U1 RNP (OR 0.43 [95% CI 0.20, 0.93]) were less likely to be anticellular antibody negative. Conclusion: In newly diagnosed systemic lupus erythematosus, 6.2% of patients were anticellular antibody negative, and 1.5% had an isolated CMP. The prevalence of anticellular antibody–negative systemic lupus erythematosus will likely decrease as emerging nomenclature guidelines recommend that non-nuclear patterns should also be reported as a positive ANA.
AB - Objective: The spectrum of antinuclear antibodies (ANAs) is changing to include both nuclear staining as well as cytoplasmic and mitotic cell patterns (CMPs) and accordingly a change is occurring in terminology to anticellular antibodies. This study examined the prevalence of indirect immunofluorescence (IIF) anticellular antibody staining using the Systemic Lupus International Collaborating Clinics inception cohort. Methods: Anticellular antibodies were detected by IIF on HEp-2000 substrate using the baseline serum. Three serologic subsets were examined: ANA positive (presence of either nuclear or mixed nuclear/CMP staining), anticellular antibody negative (absence of any intracellular staining), and isolated CMP staining. The odds of being anticellular antibody negative versus ANA or isolated CMP positive was assessed by multivariable analysis. Results: A total of 1,137 patients were included; 1,049 (92.3%) were ANA positive, 71 (6.2%) were anticellular antibody negative, and 17 (1.5%) had an isolated CMP. The isolated CMP–positive group did not differ from the ANA-positive or anticellular antibody–negative groups in clinical, demographic, or serologic features. Patients who were older (odds ratio [OR] 1.02 [95% confidence interval (95% CI) 1.00, 1.04]), of white race/ethnicity (OR 3.53 [95% CI 1.77, 7.03]), or receiving high-dose glucocorticoids at or prior to enrollment (OR 2.39 [95% CI 1.39, 4.12]) were more likely to be anticellular antibody negative. Patients on immunosuppressants (OR 0.35 [95% CI 0.19, 0.64]) or with anti-SSA/Ro 60 (OR 0.41 [95% CI 0.23, 0.74]) or anti–U1 RNP (OR 0.43 [95% CI 0.20, 0.93]) were less likely to be anticellular antibody negative. Conclusion: In newly diagnosed systemic lupus erythematosus, 6.2% of patients were anticellular antibody negative, and 1.5% had an isolated CMP. The prevalence of anticellular antibody–negative systemic lupus erythematosus will likely decrease as emerging nomenclature guidelines recommend that non-nuclear patterns should also be reported as a positive ANA.
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U2 - 10.1002/acr.23712
DO - 10.1002/acr.23712
M3 - Article
C2 - 30044551
AN - SCOPUS:85057395115
SN - 2151-464X
VL - 71
SP - 893
EP - 902
JO - Arthritis Care and Research
JF - Arthritis Care and Research
IS - 7
ER -