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Toronto Notes 2019 Seropositive Rheumatic Disease Rheumatology RH7 Table 10. Autoantibodies and their Prevalence in Rheumatic Diseases
Autoantibody
RF
Anti-CCP
ANA
Anti-dsDNA Anti-Sm
Anti-Ro (SSA)
Anti-La (SSB)
Antiphospholipid Ab (LAC, aCLA, aB2GP)
Anti-Histone
Anti-RNP
Anti-Centromere
Anti-Topoisomerase I (formerly Scl-70)
Anti-Jo1 c-ANCA p-ANCA
Anti-Mi-2
Ab Against RBCs, WBCs, or Platelets
Anti-mitochondria
Disease
RA 80% SS 50% SLE 20%
RA 80%
SLE 98%
MCTD 100%
SS 40-70%
CREST 60-80%
(Often seen in other CTDs)
SLE 50-70% SLE <30%
SS 40-95% SSc 21% SLE 32% RA 15%
SS 40% SLE 10%
APLS 100% SLE 31-40%
Drug-induced SLE 95% SLE 30-80%
MCTD SLE
Limited SSc (CREST) >80%
Diffuse SSc 26-76%
PM DMM
Active GPA >90%
GPA 10%
Other vasculitis
DMM 15-20% SLE
Primary biliary cholangitis
Healthy Controls
<5% 10-20% >65
High titers <5%
Low titers
Up to 30%,
Prevalence of non-disease related ANA rises with age
0% 0%
0.5%
0%
<5%
0% 0%
0% 0%
0% 0% 0%
0%
Comments
Serologic hallmark of RA
Autoantibodies directed against Fc domain of IgG
Sensitive in RA (can be negative early in disease course), levels correlate with disease activity
May be present in ANA positive diseases, often in lower titre
Non-specific; may be present in IE, TB, hepatitis C, silicosis, sarcoidosis
Specific for RA (94-98%)
May be useful in early disease and to predict aggressive disease, can occur before clinical disease apparent
Ab against nuclear components (DNA, RNA, histones, centromere)
Sensitive but not specific for SLE
Given high false positive rate - only measure when high pre-test probability of CTD
Specific for SLE (95%)
Levels correlate with disease activity (i.e. SLE flare)
Specific but not sensitive for SLE
Does not correlate with SLE disease activity
If positive, will remain positive through disease course
Subacute cutaneous SLE (74%)
May be only Ab present in ANA negative SLE
Increases risk of having child with neonatal lupus syndrome
Usually occurs with anti-Ro
Specific for SS and SLE when anti-Ro is also positive Increases risk of having child with neonatal lupus syndrome
By definition present in APLS
Only small subset of SLE patients develop clinical syndrome of APLS If positive, will often get a false positive VDRL test
Highly specific for drug-induced SLE
High titres present in MCTD; present in many other CTDs (especially SLE)
Specific for CREST, limited cutaneous variant of systemic sclerosis
Specific for SSc
Increased risk pulmonary fibrosis in SSc
Less frequent for DMM Specific and sensitive
Nonspecific and poor sensitivity (found in ulcerative colitis, PAN, microscopic polyangiitis, Churg-Strauss, rapidly progressive glomerulonephritis)
Specific but not sensitive (not available in all centres)
Perform direct antiglobulin test (DAT), test Hb, reticulocyte, leukocyte and platelet count, antiplatelet Abs
Sensitive and specific
Note: some individuals in the normal population test positive for RF and/or ANA, but do not have the conditions listed above