Clinical and serological features of patients referred through a rheumatology triage system because of positive antinuclear antibodies

• Published in: PloS one 2014-04, Vol.9 (4), p.e93812-e93812
• Main Authors: Fitch-Rogalsky, Christie, Steber, Whitney, Mahler, Michael, Lupton, Terri, Martin, Liam, Barr, Susan G, Mosher, Dianne P, Wick, James, Fritzler, Marvin J
• Format: Article
• Language: English
• Subjects: Analysis; Antibodies; Antibodies, Antinuclear - blood; Antibodies, Antinuclear - immunology; Antinuclear antibodies; Autoantibodies; Autoimmunity; Biology and Life Sciences; Classification; Computed tomography; Criteria; Demographics; Ethics; Family physicians; Fluorescent Antibody Technique, Indirect; Health aspects; Humans; Immunoassay; Immunoglobulins; Laboratories; Lupus; Medical diagnosis; Medical referrals; Medicine; Medicine and Health Sciences; Patients; Rheumatic diseases; Rheumatic Diseases - blood; Rheumatic Diseases - diagnosis; Rheumatoid arthritis; Rheumatology; Rheumatology - methods; Ribonucleoproteins - immunology; Systemic lupus erythematosus; Triage - methods
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0093812

The referral of patients with positive anti-nuclear antibody (ANA) tests has been criticized as an inappropriate use of medical resources. The utility of a positive ANA test in a central triage (CT) system was studied by determining the autoantibody profiles and clinical diagnoses of patients referred to rheumatologists through a CT system because of a positive ANA test. Patients that met three criteria were included: (1) referred to Rheumatology CT over a three year interval; (2) reason for referral was a "positive ANA"; (3) were evaluated by a certified rheumatologist. The CT clinical database was used to obtain demographic and clinical information and a serological database was used to retrieve specific ANA and/or extractable nuclear antigen (ENA) test results. Clinical information was extracted from the consulting rheumatologist's report. 15,357 patients were referred through the CT system; 643 (4.1%) of these because of a positive ANA and of these 263 (40.9%) were evaluated by a certified rheumatologist. In 63/263 (24%) of ANA positive patients, the specialist provided a diagnosis of an ANA associated rheumatic disease (AARD) while 69 (26.2%) had no evidence of any disease; 102 (38.8%) had other rheumatologic diagnoses and 29 (11%) had conditions that did not meet AARD classification criteria. Of ANA positive archived sera, 15.1% were anti-DFS70 positive and 91.2% of these did not have an AARD. This is the first study to evaluate the serological and clinical features of patients referred through a CT system because of a positive ANA. The spectrum of autoantibody specificities was wide with anti-Ro52/TRIM21 being the most common autoantibody detected. Approximately 15% of referrals had only antibodies to DFS70, the vast majority of which did not have clinical evidence for an AARD. These findings provide insight into the utility of autoantibody testing in a CT system.