Auto-Antibody Patterns

Research

HAPS Executive
Locked Bag 1
Hunter Region Mail Centre
NSW 2310, Australia

Phone: (02) 4921 4000
Fax: (02) 4921 4400

International Enquiries
Phone: +61 2 4921 4000
Fax: +61 2 4921 4400

Antibodies directed against structures in our own body arise as part of the normal immune response to various infections. The persistence of such antibodies, in the presence of suggestive clinical features, is supportive and sometimes diagnostic of autoimmune disease. This table summarises some of the more common autoantibodies and their clinical associations with autoimmune conditions.

A schematic description of the common methodologies used to define anti-nuclear antibodies (ANA) or anti-neutrophil cytoplasmic antibodies (ANCA) is provided.

Autoantibody patterns are a useful tool in screening for specific antigens. However, specific identification of the exact antigenic target by other testing methods (CIE, EIA, RIA, IB) is required before conclusions can be drawn about disease diagnosis, expression, prognosis and activity. The clinical use of each specific autoantibody test result may be to screen for possible autoimmune disease (Screen), diagnose a specific autoimmune disease (Diagnostic) or to assist in determining the clinical prognosis (Prognosis), pattern of disease expression (Expression) or activity (Activity) of an autoimmune disease.

Pattern on IDIF	Target Antigen	Clinical Use	Clinical Association	Testing Methods
Homogeneous ANA	Deoxynucleoprotein and histones	Screen	Connective-tissue disease Present in 8% of normals Drug-induced lupus	IDIF
Homogeneous ANA	dsDNA	Diagnostic Prognostic Activity	SLE (Specific) Increased renal disease Parallels disease activity in some patients	IDIF RIA ELISA
Speckled ANA (coarse)	Sm	Diagnostic	SLE (Specific)	IDIF IB ELISA
Speckled ANA (coarse)	U1-RNP	Expression	Mixed connective tissue disease SLE	IDIF IB ELISA
Speckled ANA (fine)	SS-A (Ro)	Expression	Sjogren's syndrome Subacute cutaneous lupus Neonatal lupus	IDIF CIE IB ELISA
Speckled ANA (fine)	SS-B (La)	Expression	Sjogren's syndrome Subacute cutaneous lupus Neonatal lupus	IDIF CIE IB ELISA
Cytoplasmic +/- Nucleolar	Ribosomal-P	Diagnostic ?Expression	SLE (specific) Psychotic and renal disease in lupus (controversial)	IDIF CIE ELISA IB
Speckled and Nucleolar ANA	Scl-70 (Anti- topoisomerase-1)	Diagnostic Prognostic	Scleroderma (Specific) Interstitial lung disease	IDIF CIE IB ELISA
Nucleolar ANA	Pm-Scl	Diagnostic Expression	Polymyositis /scleroderma overlap syndrome	IDIF CIE IB ELISA
Nucleolar ANA	RNA polymerase 1	Diagnostic Prognostic	Scleroderma Increased risk of renal disease	IDIF IB ELISA
Nucleolar ANA	U3-RNP (Fibrillarin)	Diagnostic	Scleroderma	IDIF IB
Centromere ANA	Centromere	Diagnostic Prognostic	CREST syndrome Generally benign outlook	IDIF IB ELISA
Cytoplasmic or Negative ANA	Jo-1	Diagnostic Prognostic	Polymyositis Interstitial lung disease	IDIF IB ELISA
Cytoplasmic staining with perinuclear accentuation	C-ANCA	Screen Diagnostic Prognostic ?Activity	Wegeners granulomatosis Other small-vessel vasculitides	IDIF ELISA
Perinuclear staining	P-ANCA	Screen Diagnostic Prognostic ?Activity	Idiopathic rapidly progressive glomerulonephritis Other small vessel vasculitides	IDIF ELISA
	Anti-cardiolipin antibody	Diagnostic	Antiphospholipid antibody syndrome Lupus anticoagulant should also be tested	ELISA
	Rheumatoid factor	Screen Prognostic	RA Other autoimmune diseases Infections Normals Associated with increased risk of extra-articular complications	NPA ELISA
Testing Method Code:	ELISA	Enzyme-linked immunosorbent assay
	CIE	Counter-Immunoelectrophoresis
	IB	Immunoblotting assay
	IDIF	Indirect immunofluorescence
	NPA	Nephelometric Particle Agglutination
	RIA	Radioimmunoassay

Written by:                     Dr Glenn Reeves, Immunology, HAPS
Written:                          October 1998
Reviewed:                      August 2001