ANA Patterns

SLE

• Homogenous chromatin (but homogenous histone is drug related)
• Rim pattern (chromatin and nuclear membrane)
• Fine speckled (nuclear RNP and chromatin.. but more common in other CTD)

ANA Patterns and Associations

Homogenous Pattern

Anti-Histone:  Drug SLE (Homos have Drug History)

Also present in 50-70% of SLE.

ANA Patterns

Speckled

(Anti-Centromere)

CREST Syndrome

(CREST toothpaste has speckles in the center)

• Anti-Centromere present in 70-85% of pts w limited scleroderma/CREST
• Anti-Centromere present in <5% of SLE.
• Assoc w Raynauds phenomena

ANA Patterns and Associations

Cytoplasmic/ Anti Ribosomal

Psychiatric Lupus

(CRazy People w lupus (Psychiatric SLE) have Cytoplasmic, Anti Ribosomal

ANA Patterns

Nucleolar or

Fine Speckled ie nuclear RNP and chromatin

Scleroderma

Autoantibody Associations

SLE

• ANA is sensitve  ('Ana is sensitive to ..')
• Anti-Sm and  DS DNA are specific ('Donna Smith is NOT sensitive but is Specifically Looney )

ANA in a primary care setting:

• Sensitivity-100%
• Specificity-67%
• PPV: 12%
• NPV: 100%
• Negative ANA is useful, but a +ANA present in many dz and in normals (>5%)

 Autoantibody specificity:

Anti SM (U1, U2, U4-6, snRNP)

Specific for Systemic Lupus (SLE)

• Present in 30-40% of SLE
• Very uncommon in other diseases
• Assoc w interstitial lung dz

Autoantibody Associations

Ro (SS-A) and La (SS-B)

Specificity: Sjogrens (60-70% of pts w Sjogrens)

• Ro also present in 25-30% of SLE. La also present in 10-15% of SLE
• Also assoc w Subacute cutaneous lupus

• Anti-Ro (not La): Neonatal lupus with heart block

(Sing Ro Ro Ro your boat to babies-- from the heart

vs

Babies drown from Ro boats)

Autoantibody Associations

Anti Jo-1

• Specificity: present in 40-50% of pts w Polymyositis/Dermatomyositis, especially with pulmonary interstitial disease and arthritis

(Jo mamma has muscle disease and trouble breathing and arthritis)

• Also present in <5% of SLE.

 Autoantibody specificity

SCL-70 (topoisomerase 1)

 PSS (Progressive Systemic Sclerosis)

(40-70% of pts w diffuse PSS)

• Present in <5% of SLE.

Autoantibody specificity

Histone (histone proteins)

Drug induced Lupus

• Also present in 50-70% of SLE.

Autoantibody specificity

Nuclear RNP (U1 snRNP)

Specific for MCTD (100% of pts w MCTD)

• Also present in 30-40% of SLE
• Assoc w MCTD sx, overlap SLE
• Also DM/PM, PSS