1. Evaluation of diagnostic tests for antinuclear antibodies in rheumatological practice.
- Author
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Ulvestad E, Kanestrøm A, Madland TM, Thomassen E, Haga HJ, and Vollset SE
- Subjects
- Animals, Antibody Specificity, Antigens, Nuclear, Autoantigens immunology, Autoimmune Diseases blood, Carcinoma, Squamous Cell pathology, Cell Line, Connective Tissue Diseases blood, Cross-Sectional Studies, DNA immunology, Evaluation Studies as Topic, Fluorescent Antibody Technique, Indirect, Humans, Kidney, Laryngeal Neoplasms pathology, Lupus Erythematosus, Systemic blood, Lupus Erythematosus, Systemic immunology, Mice, Nuclear Proteins immunology, ROC Curve, Reproducibility of Results, Sensitivity and Specificity, Sjogren's Syndrome blood, Sjogren's Syndrome immunology, Tumor Cells, Cultured, Antibodies, Antinuclear blood, Autoimmune Diseases immunology, Connective Tissue Diseases immunology, Enzyme-Linked Immunosorbent Assay, Immunoenzyme Techniques, Rheumatology methods
- Abstract
To investigate and compare the accuracy and usefulness of diagnostic tests for antinuclear antibodies (ANA) a cross-sectional study of sera derived from patients admitted to the Department of Rheumatology was tested for the presence of ANA using either indirect immunofluorescence on HEp-2 cells, indirect immunoperoxidase techniques on HEp-2 cells and mouse kidney, or two commercial enzyme-linked immunosorbent assays (ELISA). The diagnostic sensitivity and predictive values of the tests were calculated and compared. The accuracy of tests was compared using receiver-operating characteristics (ROC) methodology. All ANA-positive sera were further analysed for the presence of antibodies against extractable nuclear antigens (anti-ENA) and anti-DNA. A moderate to good agreement was found between tests, with kappa ranging from 0.469 to 0.659. Highest sensitivity for systemic lupus erythematosus (SLE; 93.3%) and primary Sjögren's syndrome (SS; 70%) was found using immunofluorescence on HEp-2 cells. Immunofluorescence on HEp-2 cells performed statistically better than the other tests in predicting SLE but not SS. All tests except mouse kidney showed good and comparable performance in detecting sera with anti-ENA and anti-DNA. At the given cut-off values indirect immunofluorescence on HEp-2 cells performed best. All assays except mouse kidney showed performance characteristics sufficient for use in routine analysis of ANA.
- Published
- 2000
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