The antinuclear antibody dense fine speckled pattern & possible clinical associations: indicates a proinflammatory environment, 2020, Lundgren et al

The antinuclear antibody dense fine speckled pattern and possible clinical associations: An indication of a proinflammatory microenvironment (2020) Lundgren et al

Abstract
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).

Link to abstract: here

 

Thanks. Very apropos to my diagnosis in the year 2000. I don't have the specifics of the ANA test other than its level (1:640) and I got the diagnoses of nonspecific autoimmune disorder, fibromyalgia, chronic pain syndrome, chronic fatigue syndrome.

I am overdue for an IF ANA-test. Wonder if my autoimmune system is still active. Do have (very) transient fevers.

 

Who knows whether it is available for clinical use?
Would like to bring this article to the attention to @Jonathan Edwards to the new paper. I am sure he delved plenty in ANA over the years. In the past he has mentioned that ANA didn’t mean a whole lot and that positive ANA was common for the healthy population.

 

ANA at low titre is quite common in healthy people but at higher titres it is very significant and involved in pathology in a range of autoimmune diseases.

Thisparticular paper does not seem to me to tell us anything very new or useful. There are lots of ANA patterns.Picking out the most clinically useful ones has taken forty years and continues. It needs careful epidemiological evidence. My impression that this study is not particularly hot on methodology and the rather vague conclusion reflects not finding anything very clear cut.