ANA immunofluorescence versus profile-how well they perform in autoimmune diseases: an analysis of their clinical utility in a tertiary care centre

Authors

  • Velammal Petchiappan Department of Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
  • Adityan Guhan Department of Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
  • Sumitra Selvam Department of Biostatistics, St. John’s Medical College, Bangalore, Karnataka, India
  • V. N. Nagaprabu Department of Rheumatology, Sakthi Rheumatology Centre, Coimbatore, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20183659

Keywords:

Antinuclear antibody, ANA immunoprofile, Immunofluorescence, Immunofluorescence versus profile

Abstract

Background: While Immunofluorescence assay remains the gold standard for the detection of ANA, Immunoprofile by ELISA is being increasingly utilized in view of easy availability and quick results. The study was done to find out whether ANA profile results are comparable with IFA.

Methods: About 100 patients who had undergone both immunofluorescence and Immunoprofile were included. Immunofluorescence correlation with profile and their correlation with the disease were analyzed; sensitivity, specificity and predictive values were calculated.

Results: ANA was positive in 78% by immunofluorescence; 73% by ANA profile. 22 patients in whom ANA IFA was negative were picked up by ANA profile. 27 patients who were not detected by ANA profile were tested positive by IFA. ANA testing by immuno profile had a sensitivity of 65% with a positive predictive value of 69% when compared with IFA. Immunofluorescence pattern and ANA profile correlated with the diagnosed disease in 63% and 49% respectively. Immunofluorescence pattern correlated with the ANA profile in only 35% of the study subjects. On correlation with the disease, ANA profile scored less compared to ANA-IFA with a sensitivity and specificity of 46% each; positive predictive value of 59%; negative predictive value of 33%. On analysis of individual disease, ANA profile is as good as IFA in SLE and scleroderma in terms of sensitivity. In Sjogren’s syndrome and MCTD, specificity and positive predictive value of ANA profile is high.

Conclusions: ANA IFA performs better than immunoprofile in the diagnosis of autoimmune diseases.

References

Hargraves MM, Richmond H, Morton R. Presentation of two bone marrow elements: the 'tart' cell and the LE cell. Proceedings of the Mayo Clinic. 1948;23:25-8.

Satoh M, Chan EKL, Sobel ES, Kimpel DL, Yamasaki Y, Narain S, et al. Clinical implication of autoantibodies in patients with systemic rheumatic diseases. Exp Rev Clin Immunol. 2007;3:721-38.

Monestier M, Kotzin BL. Antibodies to histones in systemic lupus erythematosus and drug-induced lupus syndromes. Rheum Dis Clin North Am. 1992;18:415-36.

Fishbein E, Alarcon-Segovia D, Vega JM. Antibodies to histones in systemic lupus erythematosus. Clin Exp Immunol. 1979 Apr;36(1):145.

Kumar Y, Bhatia A, Minz RW. Antinuclear antibodies and their detection methods in diagnosis of connective tissue diseases: a journey revisited. Diagnostic Pathology. 2009 Dec;4(1):1.

Colglazier CL, Sutej PG. Laboratory testing in the rheumatic diseases: a practical review. South Med J. 2005 Feb 1;98(2):185-91.

Habash-Bseiso DE, Steven HY, Glurich I, Goldberg JW. Serologic testing in connective tissue diseases. Clin Med Res. 2005;3:190-3.

Nakamura RM, Peebles CL, Rubin RL, Molden DP, Tan EM. Autoantibodies to nuclear antigens (ANA), 2nd ed. American Society of Clinical Pathologists Press, Chicago, Ill. 1985.

White RH, Robbins DL. Clinical significance and interpretation of antinuclear antibodies. West J Med. 1987 Aug;147(2):210-13.

Zweiman, B, Lisak RP. Autoantibodies: autoimmunity and immune complexes, p. 885–911. In J. B. Henry (ed.), Clinical and diagnosis management by laboratory methods, 18th ed. W. B. Saunders Company, Philadelphia, Pa. 1991.

Abeles AM, Abeles M. The clinical utility of a positive antinuclear antibody test result. Am J Med. 2013 Apr;126(4):342-8.

Priyadarshini S, Meenakshisundaram J, Pothini J. A Comparative study of enzyme linked immunosorbent assay (ELISA) with immunofluorescence assay (IFA) for the detection of antinuclear antibodies. Int J Pharm Bio Sci. 2013 Oct;4(4):(B)75-80.

Baronaite R, Engelhart M, Mørk Hansen T, Thamsborg G, Slott Jensen H, Stender S, et al. A comparison of anti-nuclear antibody quantification using automated enzyme immunoassays and immunofluorescence assays. Autoimmune Dis. 2014:534759.

Angel J, Thomas M, Appalaraju B. Evaluation of ELISA and indirect immunofluorescence in the diagnosis of autoimmune diseases and their interpretation in the clinical situation. J Acad Clin Microbiol. 2015 Jan 1;17(1):7.

Gniewek RA, Stites DP, Thomas MM, Joan FH, Mayumi Nakagawa. Comparison of antinuclear antibody testing methods: immunofluorescence assay versus enzyme immunoassay. Clin Diag Lab Immunol. 1997;4(2):185-8.

Minz RW, Kumar Y, Saikia B, Anand S, Varma S, Singh S. Use of panel testing for detection of antinuclear antibody in a resource-limited setting: an appraisal. Postgrad Med. 2016 Nov;128(8):869-74.

Kolahi S, Bonyadi MR, Safarzadeh E, Ghojazadeh M, Pishahang E. Diagnostic value of Immunoblotting assay for Determination of anti-nuclear antibodies in rheumatic diseases. Adv Biores. 2017 Jul 1;8(4):153-8.

Madhavi Latha B, Anil Kumar B. Detection of antinuclear antibodies by indirect immunofluorescence method and its comparison with line immunoassay in a tertiary care hospital: A laboratory based observational study. J Med Sci Res. 2014;2(4):194-9.

Raman S, Adhya AK, Pradhan P, Dash K, Senapati U. Correlation of indirect immunofluorescence and line immunoassay method in detection of autoimmune diseases: an observational study at a tertiary care teaching hospital. Sch J App Med Sci. 2017;5(7A):2520-6.

Hayashi N, Kawamoto T, Mukai M, Morinobu A, Koshiba M, Kondo S, et al. Detection of antinuclear antibodies by use of an enzyme immunoassay with nuclear HEp-2 cell extract and recombinant antigens: comparison with immunofluorescence assay in 307 patients. Clin Chem. 2001 Sep 1;47(9):1649-59.

Tanaka N, Muro Y. Anti-SSA/Ro antibody determination by indirect immunofluorescence and comparison of different methods of antinuclear antibody screening. Mod Rheumtol. 2008;18(6):585-92.

Sebastian W, Roy A, Kini U, Mullick S. Correlation of antinuclear antibody immunofluorescence patterns with immune profile using line immunoassay in Indian scenario. Indian J Pathol Microbiol. 2010;53(3):427-32.

Meroni PL, Schur PH. ANA screening: an old test with new recommendations. Ann Rheum Dis. 2010;69(8):1420-2.

James K1, Meek G. Evaluation of commercial enzyme immunoassays compared to immunofluorescence and double diffusion for autoantibodies associated with autoimmune diseases. Am J Clin Pathol. 1992 Apr;97(4):559-65.

González C, Martin T, Arroyo T, García-Isidoro M, Navajo JA, González-Buitrago JM. Comparison and variation of different methodologies for the detection of autoantibodies to nuclear antigens (ANA). J Clin Lab Anal. 1997;11:388-92.

Homburger HA1, Cahen YD, Griffiths J, Jacob GL. Detection of antinuclear antibodies: comparative evaluation of enzyme immunoassay and indirect immunofluorescence methods. Arch Pathol Lab Med. 1998 Nov;122(11):993-9.

Nossent H1, Rekvig OP. Antinuclear antibody screening in this new millennium: farewell to the microscope? Scand J Rheumatol. 2001;30(3):123-6.

Divate S1, Hardikar P, Bichile LS, Rajadhyaksha A. Clinical utility of screening for antinuclear antibodies by enzyme immunoassay-a preliminary study. J Assoc Physicians India. 2004 Apr;52:290-3.

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Published

2018-08-25

How to Cite

Petchiappan, V., Guhan, A., Selvam, S., & Nagaprabu, V. N. (2018). ANA immunofluorescence versus profile-how well they perform in autoimmune diseases: an analysis of their clinical utility in a tertiary care centre. International Journal of Research in Medical Sciences, 6(9), 3140–3146. https://doi.org/10.18203/2320-6012.ijrms20183659

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Original Research Articles