Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Antinuclear antibody (ANA) test is positive in nearly 95% of patients with systemic sclerosis (SSc) [1]. We aim to identify the clinical relevance of common ANA patterns in SSc, of which there are only few published studies [2][3].
Methods: We evaluated 186 outpatients who met criteria for SSc [4] and were seen between 2010 and 2015. We collected pertinent clinical information, including ANA patterns (Homogeneous (H-ANA), speckled (S-ANA), nucleolar (N-ANA), centromere (C-ANA), and mixed [3]) performed by Indirect Immunofluorescence (IIF) and SSc auto-antibodies: RNA Polymerase III (POL3), Anti-topoisomerase I (anti-topo I), U-1 RNP, and Anti-Centromere (ACA).
Results: ANA was positive in 92% of patients (n=171) with the following patterns: H-ANA 27%, S-ANA 26%, N-ANA 12%, C-ANA 20% and mixed 14% (homogeneous & speckled 3%, homogeneous & nucleolar 5%, speckled & nucleolar 4%, speckled & centromere 1% and nucleolar & centromere 1%). H-ANA was strongly associated with both anti-topo I (OR 24, CI 10.3-55.8) and diffuse cutaneous systemic sclerosis (dcSSc) (OR 5.5, CI 2.4-12.6). In addition, H-ANA was significantly associated with later age of disease onset, acro-osteolysis, hand contractures, interstitial lung disease (ILD), and lower forced vital capacity (FVC) and diffusion capacity of the lung for carbon monoxide (DLCO). S-ANA was strongly associated with POL 3 (OR 11.4, CI 4.4-29.9), U-1RNP (OR 7.3, CI 3-17.8), and tendon friction rubs (TFRs) (OR 2.8, CI1.3-5.9). C-ANA was strongly associated with limited cutaneous systemic sclerosis (lsSSc) (OR 71, CI 9.4-533), and strongly protective against myopathy (OR 0.1, CI 0.01-0.8), TFRs (p=0.0002), hand contractures (OR 0.2, CI 0.08-0.7), and ILD (OR 0.3, CI 0.1-0.7). These patients had higher %FVC (p<0.0001) and %DLCO (p=0.006). None of the SSc auto-antibodies were associated with the nucleolar pattern.
Conclusion: ANA patterns may be useful in predicting specific SSc auto-antibodies and clinical features. Larger studies could confirm our findings and help further understand the clinical significance of these ANA patterns in SSc. References:
1- Bernstein et al. Clin Exp Imm. 1982; 48:43
2- Hesselstrand et al. Rheumatology 2003; 42:534
3- Sulli et al. J.Rheum. 2013;40:5
4- Hoogen et al. Ann Rheum Dis. 2013; 72:1747 & Arthritis Rheum. 2013;65: 2737
| Table-1 Patient Demographics and Systemic Sclerosis subtypes in relation to ANA patterns | ||||||||
| ANA Positive n=171 (92%) | ANA pattern by Indirect Immunofluorescence | ANA Negative n=15(8%) | ||||||
| Homogenous n=47 (27%) | Speckled n=45 (26%) | Centromere n=34(20%) | Nucleolar n=21(12%) | Mixed n=24(14%) | ||||
| Mean (SD) or Col% | Mean(SD) or Col% | Mean(SD) or Col% | Mean(SD) or Col% | Mean(SD) or Col% | Mean(SD) or Col% | Mean(SD) or Col% | ||
| Age (years) | 58.4(13) | 59.7(11) | 56(13) | 62.4 (14.2) | 55(11.8) | 57.4(14.8) | 62.4(13) | |
| Female Male | 145(85%) 26(15%) | 38(81%) 9(19%) | 39(87%) 6(13%) | 32(94%) 2(6%) | 15(71%) 6(29%) | 21(88%) 3(12%) | 12(80%) 3(20% | |
| Caucasian AA Other | 114(67%) 20(12%) 36(21%) | 31(66%) 7(15%) 9(19%) | 31(69%) 7(16%) 7(16%) | 25(76%) 0(0%) 8(24%) | 12(57%) 3(14%) 6(29%) | 15(63%) 3(12%) 6(25%) | 12(80%) 1(7%) 2(13%) | |
| Hispanic Non-Hispanic | 13(8%) 157(92%) | 1(2%) 46(98%) | 1(2%) 44(98%) | 4(12%) 29(88%) | 2(10%) 19(10%) | 5(21%) 19(79%) | 1(7%) 14(93%) | |
| SSc type | Diffuse Limited | 94(55%) 76(45%) | 39(83%)a 8(17%) p<0.0001 | 26(59%) 18(41%) | 1(3%) 33(97%)b p<0.0001 | 13(62%) 8(38%) | 15(63%) 9(37%) | 10(67%) 5(33%) |
| Age at SSc Onset (year)* | 44.7(12.8) | 48.3(10.3) p=0.004 | 44.4(12.4) | 44(13.2) | 42(12.9) | 41.6(16.6) | 48(11.7) | |
| Overlap w/ RA | Yes No | 38(22%) 131(78%) | 12(26%) 34(74%) | 14(31%) 31(69%) | 5(15%) 29(85%) | 4(19%) 17(81%) | 3(12%) 21(88%) | 3(20%) 12(80%) |
| Overlap w/Myositis | Yes No | 31(19%) 136(81%) | 9(20%) 37(80%) | 13(29%) 32(71%) | 1(3%)c 32(97%) p=0.008 | 5(24%) 16(76%) | 4(17%) 19(83%) | 4(29%) 10(71%) |
a-OR=5.5, CI(2.4-12.6) b-OR=71, CI(9.4-533) c-OR=0.1, CI(0.01-0.8) *From non-RaynaudÕs symptoms SSc: systemic sclerosis; dcSSc: diffuse cutaneous systemic sclerosis; lcSSc: limited cutaneous systemic sclerosis; RA: rheumatoid arthritis
| Table-2: Systemic Sclerosis-specific auto-antibodies in relation to ANA patterns | |||||||||
| ANA Positive n=171 (92%) | ANA pattern by Indirect Immunofluorescence | ANA Negative n=15 (8%) | |||||||
| Homogenous n=47 (27%) | Speckled n=45 (26%) | Centromere n=34 (20%) | Nucleolar n=21(12%) | Mixed n=24 (14%) | |||||
| Mean (SD) or Col% | Mean (SD) or Col% | Mean (SD) or Col% | Mean (SD) or Col% | Mean (SD) or Col% | Mean (SD) or Col% | Mean (SD) or Col% | |||
| Anti-topo I | Positive Negative | 50(29%) 120(71%) | 35(74%) 12(26%) p<0.0001a | 4(9%) 41(91%) | 0(0%) 33(100%) | 0(0%) 21(100%) p=0.003 | 11(46%) 13(54%) | 0(0%) 15(100%) p=0.01 | |
| RNA-polymerase III | Positive Negative | 23(16%) 122(84%) | 4(10%) 38(90%) | 17(45%) 21(55%) p<0.0001b | 0(0%) 28(100%) | 0(0%) 17(100%) p=0.05 | 2(12%) 15(88%) | 2(14%) 12(86%) | |
| Anti-Centromere | Positive Negative | 42(25%) 127(75%) | 0(0%) 46(100%) p<0.0001 | 4(9%) 40(91%) p=0.01 | 34(100%) 0(0%) p<0.0001 | 0(0%) 21(100%) p=0.003 | 4(21%) 15(79%) | 0(0%) 15(100%) p=0.02 | |
| Anti-U-1 RNP | Positive Negative | 26(16%) 141(84%) | 3(7%) 42(93%) | 16(36%) 28(64%) p<0.0001c | 2(6%) 31(94%) | 1(5%) 20(95%) | 4(17%) 20(83%) | 0(0%) 15(100%) | |
a-OR=24, CI(10.3-55.8) b-OR=11.4, CI(4.4-29.9) c-OR=7.3, CI(3-17.8) Anti-topo I: anti-topoisomerase I or Scl70
| Table-3 Systemic Sclerosis clinical features in relation to ANA patterns | ||||||||||
| ANA Positive n=171 (92%) | ANA pattern by Indirect Immunofluorescence | ANA Negative n=15 (8%) | ||||||||
| Homogenous n=47 (27%) | Speckled n=45 (26%) | Centromere n=34 (20%) | Nucleolar n=21(12%) | Mixed n=24 (14%) | ||||||
| Mean (SD) or Col% | Mean (SD) or Col% | Mean (SD) or Col% | Mean (SD) or Col% | Mean (SD) or Col% | Mean (SD) or Col% | Mean (SD) or Col% | ||||
| Digital ulcers* | Yes No | 91(54%) 77(46%) | 28(60%) 19(40%) | 22(49%) 23(51%) | 24(71%) 10(29%) | 7(37%) 12(63%) | 10(43%) 13(57%) | 5(33%) 10(67%) | ||
| TFRs* | Yes No | 42(29%) 103(71%) | 14(34%) 27(66%) | 18(44%) 23(56%) p=0.007 | 0(0%) 30(100%) p=0.0002 | 5(31%) 11(69%) | 5(29%) 12(71%) | 2(14%) 12(86%) | ||
| Synovitis* | Yes No | 44(28%) 111(72%) | 15(36%) 27(64%) | 17(40%) 26(60%) | 5(16%) 27(84%) | 4(22%) 14(78%) | 3(14%) 18(86%) | 3(20%) 12(80%) | ||
| Acro-osteolysis** | Yes No | 35(24%) 112(76%) | 15(38%) 25(62%) p=0.04 | 4(10%) 35(90%) | 4(14%) 25(86%) | 3(17%) 15(83%) | 9(43%) 12(57%) | 5(42%) 7(58%) | ||
| Calcinosis** | Yes No | 69(48%) 76(52%) | 18(45%) 22(55%) | 15(38%) 24(62%) | 16(55%) 13(45%) | 8(47%) 9(53%) | 12(60%) 8(40%) | 6(50%) 6(50%) | ||
| Hand Contractures* | Yes No | 54(34%) 104(66%) | 20(47%) 23(53%) p=0.03 | 15(36%) 27(64%) | 4(13%) 27(87%) p=0.008 | 5(25%) 15(75%) | 10(45%) 12(55%) | 3(23%) 10(77%) | ||
| ILD *** | Yes No | 101(68%) 47(32%) | 39(83%) 8(17%) p=0.01 | 27(68%) 13(32%) | 10(43%) 13(57%) p=0.005 | 13(72%) 5(28%) | 12(60%) 8(40%) | 10(71%) 4(29%) | ||
| FVC (%) | 81.6%(20) | 71.9%(17) p=0.02 | 83.1%(16.8) | 97.2%(18.1) p<0.0001 | 72.8%(19.4) | 82.6%(21.8) | 71.6%(26.3) | |||
| DLCO (%) | 64.3%(23.2) | 55.2%(20.4) p=0.05 | 65.5%(21.5) | 69.4%(20.8) p=0.006 | 66.3%(29.9) | 70.5%(24.2) | 48.5%(24.6) | |||
| Current mRSS* (SD) | 4(6.6) | 5.2(7.4) | 4.2 (6.3) | 2.2(2.7) | 3.3(8.0) | 4.4(7.8) | 2.1(4.4) | |||
*Documented on physical exam **Documented by hand x-rays ***Document by high resolution CT chest TFRs: tendon friction rubs; ILD: interstitial lung disease; FVC: forced vital capacity; DLCO: diffusion capacity of the lung for carbon monoxide mRSS: modified Rodnan skin score
To cite this abstract in AMA style:
Raslan A, Stermer C, Hsu V. The Clinical Relevance of Common ANA Patterns in Systemic Sclerosis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/the-clinical-relevance-of-common-ana-patterns-in-systemic-sclerosis/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-clinical-relevance-of-common-ana-patterns-in-systemic-sclerosis/