Usefulness of antinuclear antibody testing to screen for rheumatic diseases

OBJECTIVE—To assess the usefulness of the indirect immunofluorescence antinuclear antibody test (FANA) using human laryngeal epithelial carcinoma cells as nuclear substrate, to screen for childhood rheumatic diseases.
STUDY DESIGN—A review of all FANA tests performed on children at British Columbia''s Children''s Hospital between 7 March 1991 and 31 July 1995.
RESULTS—FANA tests were positive at titres of 1:20 or greater in 41% of all subjects tested, and in 65% of all subjects in whom the diagnosis was obtained. FANA positivity occurred in 67% of those with a rheumatic disease, compared with 64% of those with a non-rheumatic disease (p=0.4). More girls had high titre FANA positivity than boys independent of whether or not they had a rheumatic disease (p=0.05). At a screening serum dilution of 1:40 a positive test has a sensitivity of only 0.63, and a positive predictive value of only 0.33 for any rheumatic disease. For systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD), or overlap syndrome at a screening dilution of 1:40 the test has a very high sensitivity of 0.98, but a very low positive predictive value of only 0.10,the test having slightly better characteristics for boys than girls.
CONCLUSION—Although a negative FANA test makes a diagnosis of SLE or MCTD extremely unlikely, a positive test even at moderately high titres of 1:160 or higher is found so frequently in children without a rheumatic disease that a positive result has little or no diagnostic value. It is suggested that a screening serum dilution of 1:160 or 1:320 would increase the usefulness of the test, by decreasing false positive tests, without significantly increasing false negative tests for SLE or MCTD, and would have the potential for considerable cost savings.

     

Clinical utility of antinuclear antibody tests in children

Background  

Antinuclear antibody (ANA) tests are frequently used to screen children for chronic inflammatory diseases such as systemic lupus erythematosus (SLE). However, the diagnostic utility of this test is limited because of the large number of healthy children who have low-titer positive tests. We sought to determine the clinical utility of ANA tests in screening children for rheumatic disease and to determine whether there are specific signs or symptoms that enhance the clinical utility of ANA tests in children.     

Community programs for children with rheumatic diseases

There is an evident need for both qualitative and quantitative expansion of services to children with rheumatic or connective tissue diseases. These are necessary for diagnosis, amelioration, rehabilitation and reconstruction at the physical level. They are equally important for the development of appropriate and gratifying career and other biopsychosocial goals and for the achievement of them. Two model programs have been described. Such programs should be designed to accommodate local and regional conditions within the broad context of comprehensive care. Numerous governmental and private agencies are available to assist in this process, but it is still dynamic and evolutionary.     

Radiologic investigation of rheumatic diseases

This article reviews the current use of the wide variety of imaging modalities now available, presenting the imaging features of common and important causes of acute and chronic rheumatic disorders including juvenile idiopathic arthritis, spondyloarthropathies/enthesitis-related arthritis, sepsis, autoimmune diseases, vasculitis, and osteoporosis.     

Effect of transfusions on serologic testing for antibody to varicella

Serologic testing of patients with acute lymphocytic leukemia for susceptibility to varicella was confounded by prior administration of blood products. Packed red cell transfusions produced fewer problems than plasma-rich transfusions. Seronegative individuals may be transiently seropositive for several weeks. Specimens submitted for serologic testing should be accompanied by information on recent receipt of blood products.     

自身抗体在风湿性疾病中的意义

自身免疫是泛指机体免疫系统针对自身抗原成分发生免疫应答,产生了针对自身成分的抗体和(或)致敏的淋巴细胞性免疫应答的现象。自身抗体的分析在临床应用主要有4个方面：(1)诊断风湿性疾病;(2)动态观察病情、疗效及判断愈后;(3)为不同疾病的鉴别诊断提供客观依据;(4)研究免疫病理机制和流行学调查。     

Management of rheumatic diseases in children

Rheumatic diseases are one of the common groups of chronic diseases of childhood. They are multifactorial in origin and tend to involve multiple organ systems. Consequently management of these diseases requires the expertise of many health and allied health professionals. This review article focuses on the medical management of three of the relatively common diseases: juvenile rheumatoid arthritis (JRA), systemic lupus erythematozus (SLE) and dermatomyositis (DM).     

Physical and occupational therapy for children with rheumatic diseases

Total management of rheumatic disorders of children includes antiinflammatory drugs, active therapy, maintenance of ADLs, and attention to the psychosocial development of the child. This article focuses on the role that physical and occupational therapists play in the management of children with arthritis. The complexity of the problems of these children necessitates a multidisciplinary team approach, with professionals who are committed to helping the child lead as normal a life as possible. This objective can be accomplished only by teaching families and school personnel how to manage the child's daily therapeutic needs.     

Usefulness of exercise stress testing for prediction of blood pressure trends

The purpose of this study was to determine whether values of blood pressure during exercise help predict which adolescents are prone to maintain high blood pressure. Dynamic and isometric exercise stress tests were performed on 131 adolescents who had had systolic or diastolic pressures greater than the 95th percentile on three examinations the previous year. Follow-up blood pressures were measured 1 year after the stress testing, and outcomes were classified on the basis of the blood pressure status that year. Stepwise regression analysis was used to examine the association between earlier blood pressures and exercise pressures with outcome pressures. In both male and female adolescents, the average resting systolic pressure on the earlier survey was the best predictor of systolic pressure 2 years later. Blood pressures and heart rates during dynamic and isometric exercise did not significantly contribute to the models' prediction of future systolic or diastolic pressures. The data suggest that exercise stress testing is not a valid method for predicting youths whose blood pressures will remain elevated over the next 1 to 2 years.     

Significance of a positive antinuclear antibody test in a pediatric population

Clinical and laboratory findings in 138 children seen during a ten-year period with a positive antinuclear antibody (ANA) test were reviewed. Two thirds (91 of 138) of the patients had specific autoimmune or rheumatic diseases, including systemic lupus erythematosus (n = 37), juvenile rheumatoid arthritis (n = 33), Sj?gren's syndrome (n = 9), mixed connective tissue disease (n = 7), dermatomyositis (n = 3), and discoid lupus (n = 2). Another 27 patients had symptoms of autoimmune disease but did not fit criteria for specific disorders. Nine patients with IgA deficiency had a positive ANA test but did not have symptomatic autoimmune disease. Ten children had a positive ANA test in association with infections, mainly viral, and one had leukemia. Because most children with a positive ANA test had readily diagnosable autoimmune disorders, pediatric patients with a positive ANA on repeated testing should undergo clinical and laboratory studies for autoimmune or rheumatic disease.     

关注我国儿童风湿性疾病进展

随着医学科学的不断进步,在成人风湿病专业发展的影响下,越来越多的国内儿科医师开始关注儿童风湿性疾病.尤其近20年以来,在临床诊疗、基础研究方面,我国儿童风湿病领域取得了一定的成绩,但是与发达国家相比仍然存在差距.