Background Positive ANA may lead to additional testing and potentially even inappropriate treatment in patients with rheumatic symptoms not caused by ANA associated rheumatic diseases (AARD).
Objectives It has been shown that autoantibodies directed against lens epithelial derived growth factor (LEDGF), also named DFS70 according to the staining pattern (dense fine speckled) and molecular weight of the target antigen (70 kDa), are common among ANA positive individuals with no evidence of AARD [1,2]. The aim of our study was to evaluate if autoantibodies directed against DFS70 can be used to exclude AARD in ANA positive patients.
Methods Anti-DFS70 antibody were determined by chemoluminescence assay (CIA) in sera of 352 apparently healthy controls (AHI), 1048 patients of an ANA positive routine cohort, 579 patients with AARD (300 SLE, 76 idiopathic inflammatory myopathies, 167 systemic sclerosis, 36 Sjögren's syndrome), 56 patients with undifferentiated connective tissue disease (UCTD), and 660 non-AARD patients (302 rheumatoid arthritis, 94 ANCA-associated vasculitis, 87 atopic rhinitis, 135 pediatric patients with celiac disease, and 42 autoimmune liver diseases).
Results In AHI and in the non-AARD cohort, anti-DFS70 antibodies occur with a prevalence of 5.1% and 2%, respectively. Of the 1048 selected routine sera, 205 (19.6%) were positive for anti-DFS70 antibodies. Up to now, clinical reports are available for 116 of anti-DFS70 positive patients in this group. The diagnoses were widely scattered (nonspecific rheumatic symptoms, arthritis, thyreoiditis, asthma, psoriasis, tumor, infections, inflammatory bowel disease), but no definite AARD could be diagnosed. In the AARD group, only 6 of 579 patients (1.2%) were positive for anti-DFS70 antibodies, all of them also show disease specific autoantibodies (two anti-Scl70 antibody positive SSc, one anti-RNAPIII antibody positive SSc, one Ro-52 positive SSc, one anti-Mi-2 antibody positive IIM, one SLE patient with multiple autoantibodies including dsDNA antibodies). In patients with UCTD, 6 (10.7%) were anti-DFS70 antibody positive in the absence of disease specific autoantibodies. Up to now, no development of an AARD was observed in these patients.
Conclusions Anti-DFS70 antibodies are frequently observed in sera with chromatin binding antibodies in the absence of disease specific autoantibodies. If anti-DFS70 antibodies are positive in the absence of AARD specific autoantibodies, an AARD can be excluded with high certainty.
Dellavance A, Viana VS, Leon EP, Bonfa ES, Andrade LE, Leser PG. The clinical spectrum of antinuclear antibodies associated with the nuclear dense fine speckled immunofluorescence pattern. J Rheumatol 2005;32,2144–49.
Mahler M, Hanly JG, Fritzler MJ. Importance of the dense fine speckled pattern on HEp-2 cells and anti-DFS70 antibodies for the diagnosis of systemic autoimmune diseases. Clin Dev Immunol 2012; Article ID 4943356.
Disclosure of Interest None declared