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Year : 2018  |  Volume : 16  |  Issue : 3  |  Page : 223-228

Detection of antinuclear antibody in autoimmune connective tissue diseases: a comparison between immunofluorescence and solid-phase assay

Department of Clinical Pathology, Faculty of Medicine, Assiut University, Asyut, Egypt

Correspondence Address:
Yomna M Hasan
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Asyut
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/AZMJ.AZMJ_55_17

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Background Testing for antinuclear antibodies (ANA) is useful for the diagnosis of autoimmune connective tissue diseases (CTD). Solid-phase assay such as the enzyme-linked immunosorbent (ELISA) assay has replaced the use of indirect immunofluorescence assay (IIF) for the detection of ANA. Patients and methods In this study, ELISA which is based on a qualitative screening of IgG class autoantibodies using commercially available kits from Orgetec Diagnostika GmbH was compared with IIF for the detection of ANA in patients with different connective tissue diseases. The study involved 73 patients with confirmed diagnosis (38 patients diagnosed as systemic lupus erythematosus (SLE), 27 patients with rheumatoid arthritis (RA), and eight patients with other connective tissue diseases: systemic sclerosis, mixed connective tissue diseases, and Sjögren’s syndrome). They were recruited from the outpatient clinic of the Rheumatology and Rehabilitation Department for follow-up and others were admitted patients of the Rheumatology Department at Assuit University Hospitals. Twenty-five apparently healthy participants served as the control group. Results ANA results by IIF: of the 73 patients, 39 (53.4%) had positive ANA results and 34 (46.6%) patients had negative ANA results. All healthy control group ANA results by IIF were negative (100%). ANA results by ELISA: from a total of 73 patients, 42 (57.5%) had positive ANA results, 27 (37%) patients had negative ANA results, and four (5.5%) patients had borderline ANA results. All control group ANA results by ELISA had negative ANA results. ELISA sensitivity was 86.8% compared with 84.2% by IIF in the SLE. In other CTD both tests had the same sensitivity (87.5%). The ELISA and IIF had the same high specificity (100%) in SLE and other CTD. Conclusion There is a comparable result between sensitivity, specificity, PPV, NPV, and accuracy of both ANA tests. So we can rely on the results of ELISA in our laboratories in Assuit University Hospitals as they can deal with large numbers of patients and it saves time. IIF is partly subjective, and therefore there is considerable variation in the interpretation of results between different observers, so we can avoid it. So ANA by ELISA tests can be used as a screening test and if we want to identify the ANA pattern we can use IIF on HEp-2 cells.

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