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Abstract Number: 1254

Prevalence Of Antinuclear Antibodies In Schoolchildren Across Puberty and Possible Relationship With Musculoskeletal Pain. A Longitudinal Study

Francesca Sperotto1, Sara Brachi2, Mara Seguso3, Fabio Vittadello1 and Francesco Zulian4, 1Department of Pediatrics, University of Padua, Padua, Italy, 2Department of Pediatrics, University of Ferrara, Ferrara, Italy, 3Department of Laboratory Medicine, University of Padua, Padua, Italy, 4PRINTO, Genoa, Italy

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: antinuclear antibodies (ANA) and musculoskeletal disorders, Puberty

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Session Information

Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects II: Pediatric Systemic Lupus Erythematosus, Pediatric Vasculitis and Pediatric Myositis

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Antinuclear antibodies (ANA) are frequently found in children with connective tissue diseases but can also be found in healthy individuals even in absence of autoimmune conditions, with a prevalence ranging from 13.3% (titer >1:80) to 5.0% (titer >1:160). Puberty is a period of important changes of the immune system, because of sexual and adenohypophyseal hormones modulation which may affect the onset of many autoimmune and connective tissue diseases. To date, a few studies have evaluated the role of ANA in healthy subjects but no one has explored their meaning and frequency across the puberty switch.

Aim of our study was to evaluate prevalence and persistence of ANA in subjects with no evident autoimmune disease followed for 3 years, and their possible relationship with chronic non-inflammatory musculoskeletal pain (MSP).

Methods:

Each subject underwent a general and rheumatologic examination focusing on presence of chronic non-inflammatory MSP and including the evaluation of the pubertal stage. Chronic MSP was defined as continuous or recurrent pain lasting more than 3 months and heavily interfering with daily activities, according to the International Association for the Study of Pain. Subjects with past of present sign of any neurological, skeletal, metabolic or autoimmune conditions were excluded. Family history for autoimmune diseases in first degree relatives was also investigated. Finally, each subject underwent laboratory tests to determine the presence of ANA, ENA and anti-dsDNA, following the international guidelines. Subjects with ANA positivity (titer >1:80) and/or MSP have been re-evaluated with the same methods 3 years later. 

Results:

261 subjects, aged 8-13 years, entered the study. 32 (12.3%) resulted ANA+, equally distributed as far as gender and pubertal status. None of the ANA+ subjects resulted positive at ENA or anti-dsDNA testing. A positive family history for autoimmune conditions was reported in 6.5% of the subjects.

Three years later, in the group of patients followed for MSP (no. 67) ANA-positivity significantly increased from 13.4% to 44.8% (p<0.001) showing a trend to involve more pre-pubertal subjects than the pubertal ones and more females than males. Particularly, ANA positivity involved more pubertal females than pubertal males (50.0% vs 28.0%). In the ANA-positive cohort (no. 28) 92.9% of subjects confirmed the ANA-positivity 3 years later and showed a significant increase of the autoantibody titer (p 0.002). The prevalence of positive family history did not significantly change during the study period. None of the ANA+ subjects resulted positive at ENA or anti-dsDNA testing. Overall, no significant association between ANA-positivity and chronic non-inflammatory MSP was found.

Conclusion:

Prevalence and titer of ANA increase across puberty, especially in females, but have no relationship with MSP. This phenomenon could be explained by the complex hormonal changes of the puberty switch period. Further long-term prospective studies are needed to clarify the potential role of ANA as marker of autoimmune-rheumatic conditions, particularly in this period.


Disclosure:

F. Sperotto,
None;

S. Brachi,
None;

M. Seguso,
None;

F. Vittadello,
None;

F. Zulian,
None.

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