Antinuclear Antibody–Negative Systemic Lupus Erythematosus in an International Inception Cohort

May Y. Choi, Ann E. Clarke, Yvan St. Pierre, John G. Hanly, Murray B. Urowitz, Juanita Romero-Diaz, Caroline Gordon, Sang Cheol Bae, Sasha Bernatsky, Daniel J. Wallace, Joan T. Merrill, David A. Isenberg, Anisur Rahman, Ellen M. Ginzler, Michelle Petri, Ian N. Bruce, Mary A. Dooley, Paul R. Fortin, Dafna D. Gladman, Jorge Sanchez-GuerreroKristjan Steinsson, Rosalind Ramsey-Goldman, Munther A. Khamashta, Cynthia Aranow, Graciela S. Alarcón, Susan Manzi, Ola Nived, Asad A. Zoma, Ronald F. van Vollenhoven, Manuel Ramos-Casals, Guillermo Ruiz-Irastorza, S. Sam Lim, Kenneth C. Kalunian, Murat Inanc, Diane L. Kamen, Christine A. Peschken, Soren Jacobsen, Anca Askanase, Thomas Stoll, Jill Buyon, Michael Mahler, Marvin J. Fritzler

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)893-902
Number of pages10
JournalArthritis Care and Research
Volume71
Issue number7
DOIs
StatePublished - Jul 2019

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ASJC Scopus subject areas

  • Rheumatology

Cite this

Choi, M. Y., Clarke, A. E., St. Pierre, Y., Hanly, J. G., Urowitz, M. B., Romero-Diaz, J., Gordon, C., Bae, S. C., Bernatsky, S., Wallace, D. J., Merrill, J. T., Isenberg, D. A., Rahman, A., Ginzler, E. M., Petri, M., Bruce, I. N., Dooley, M. A., Fortin, P. R., Gladman, D. D., ... Fritzler, M. J. (2019). Antinuclear Antibody–Negative Systemic Lupus Erythematosus in an International Inception Cohort. Arthritis Care and Research, 71(7), 893-902. https://doi.org/10.1002/acr.23712