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Evaluation of the titer and immunofluorescence pattern of antinuclear antibody test in systemic lupus erythematosus patients according to disease activity status


The test ANA (antinuclear antibody) or autoantibodies against cellular antigens is one of the major tests used to identify autoantibodies. One of the challenges of clinical practice in lupus patients is the monitoring of disease activity, since it is necessary to differentiate the activity itself of chronic lesions in organs, manifestations of other disorders, infections, adverse effects of medications and psychological factors. Although the ANA is a widely used test for diagnosis and classification of lupus we did not find, after extensive review of the literature, papers or research clarifying if it is also useful in the evaluation of SLE activity. Objectives: The objective of the study is to evaluate the test ANA in patients with SLE and analyze if there is any relationship between the titer and the pattern of ANA with SLE activity. For this, three groups of patients will be created, separated according to the SLEDAI score: group 1- SLEDAI equal or greater than 6 (disease activity), group 2 - SLEDAI between 1 and 5 (intermediate/undefined activity), and group 3 - SLEDAI equal to 0 (quiescent disease). If there is migration of patients between groups throughout the study, they will be evaluated again, thus obtaining two assessments of the same individual, to later compare them in two stages of the disease. Materials and Methods: 200 patients with a diagnosis of SLE according to the classification criteria of the American College of Rheumatology (ACR) revised in 1997 will be selected. The patients should be followed at the outpatient rheumatology clinic (UNIFESP / Hospital São Paulo), have signed the informed consent form, and have disease onset over 16. The patients will be divided into two groups of 50 patients each (group 1 and 3) and one group of 100 patients (group 2), according to the SLEDAI score. Patients who present a score equal or greater than 6 will be allocated in Group 1 (active disease); those showing a score equal to 0 will be allocated in Group 3 (quiescent disease): those showing SLEDAI between 1 and 5 will be allocated to Group 2 (intermediate/undefined disease activity). The ANA test will be performed for all patients, noting the titer and the immunofluorescence pattern. Tradition disease activity markers, such as anti-native DNA, anti-denatured DNA, anti-nucleosome, and anti-C1q, as well as elements of the Complement System, will be analyzed in all samples. The parameters of the ANA (titer and pattern) will be compared in groups 1 and 3, as well as on different occasions in the same individual. Monitoring of disease activity will be performed by periodic appointments at the outpatient rheumatology clinic and by bimestrial telephone interviews. The performance of ANA in relation to the status of SLE activity will be compared to the traditional markers of disease activity. Expected Results: We expect to understand the behavior of the ANA profile in relation to lupus activity by means of analysis of ANA test at different times of the disease (with and without activity), and of the possibility of evaluation among the same individuals in moments different disease, as well as by comparison with tests with well-established relationship with disease activity. (AU)

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(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
PRADO, MONICA SIMON; DELLAVANCE, ALESSANDRA; RODRIGUES, SILVIA HELENA; MARVULLE, VALDECIR; COELHO ANDRADE, LUIS EDUARDO. Changes in the result of antinuclear antibody immunofluorescence assay on HEp-2 cells reflect disease activity status in systemic lupus erythematosus. CLINICAL CHEMISTRY AND LABORATORY MEDICINE, v. 58, n. 8, p. 1271-1281, . (13/00913-6)

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