1er Consenso Uruguayo de Anticuerpos Antinucleares
Resumen
Los anticuerpos antinucleares (ANA) están presentes en una gran cantidad de enfermedades autoinmunes sistémicas (EAS), siendo un estudio muy solicitado en la práctica clínica, así como una técnica de alta demanda en los laboratorios clínicos. Si bien en la última década ha habido un gran esfuerzo regional e internacional para consensuar y estandarizar la prueba, en nuestro país los laboratorios presentan disparidad en cuanto a las técnicas utilizadas y a la dilución inicial de tamizaje. Así mismo, en la práctica clínica, la indicación de la prueba muchas veces no se encuentra bien dirigida. En el Congreso Uruguayo de Patología Clínica del 2016 se dictó un Curso de Educación Médica Continua sobre el Uso de los ANA y se reconoció una vez más la necesidad de uniformizar las prácticas tanto clínicas como de laboratorio en torno a la prueba. Con el afán de generar un 1er Consenso Uruguayo sobre ANA se conformó un grupo directivo de trabajo para discutir acerca de los temas a consensuar.
Citas
(1) Haute Autorité de Santé. Recommendations par consensus formalicé (RCF). 2010. Disponible en: www.has-sante.fr/ portail/jcms/c_272505/recommandations-par-consensus-formalise-rcf. Consulta: 16 febrero 2019.
(2) Damoiseaux J, von Mühlen CA, Garcia-De La Torre I, Carballo OG, de Melo Cruvinel W, Francescantonio PL, et al. International consensus on ANA patterns (ICAP): the bumpy road towards a consensus on reporting ANA results. Auto Immun Highlights 2016; 7(1):1.
(3) Carballo O, Ingénito F, Ginaca A, Carabajal P, Costa M, Balbaryski J. Primer Consenso Argentino para la Estandarización de la Determinación de Anticuerpos Anti-Nucleares por Inmunofluorescencia Indirecta–HEp-2. Acta Bioquím Clín Latinoam 2012; 46(1):3-13.
(4) Dellavance A, Gabriel Júnior A, Cintra AF, Ximenes AC, Nuccitelli B, von Mühlen CA, et al. I Consenso Nacional para Padronização dos Laudos de FAN HEp-2. J Bras Patol Med Lab 2002; 38(3):201-16.
(5) Dellavance A, Gabriel Júnior A, Cintra AF, Ximenes AC, Nuccitelli B, Taliberti BH, et al. II Consenso Brasileiro de Fator Antinuclear em Células HEp-2. Rev Bras Reumatol 2003; 43(3):129-40.
(6) Pérez D, Gilburd B, Azoulay D, Shovman O, Bizzaro N, Shoenfeld Y. Antinuclear antibodies: is the indirect immunofluorescence still the gold standard or should be replaced by solid phase assays? Autoimmun Rev 2018; 17(6):548-52.
(7) Pisetsky DS. Antinuclear antibody testing - misunderstood or misbegotten? Nat Rev Rheumatol 2017; 13(8):495-502.
(8) Mariz HA, Sato EI, Barbosa SH, Rodrigues SH, Dellavance A, Andrade LE. Pattern on the antinuclear antibody-HEp-2 test is a critical parameter for discriminating antinuclear antibody-positive healthy individuals and patients with autoimmune rheumatic diseases. Arthritis Rheum 2011; 63(1):191-200.
(9) Fritzler MJ. The antinuclear antibody test: last or lasting gasp? Arthritis Rheum 2011; 63(1):19-22.
(10) Tan EM, Feltkamp TE, Smolen JS, Butcher B, Dawkins R, Fritzler MJ, et al. Range of antinuclear antibodies in “healthy” individuals. Arthritis Rheum 1997; 40(9):1601-11.
(11) Solomon DH, Kavanaugh AJ, Schur PH; American College of Rheumatology Ad Hoc Committee on Immunologic Testing Guidelines. Evidence-based guidelines for the use of immunologic tests: antinuclear antibody testing. Arthritis Rheum 2002; 47(4):434-44.
(12) Agmon-Levin N, Damoiseaux J, Kallenberg C, Sack U, Witte T, Herold M, et al. International recommendations for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies. Ann Rheum Dis 2014; 73(1):17-23.
(13) Mills JA. Systemic lupus erythematosus. N Engl J Med 1994; 330(26):1871-9.
(14) Li QZ, Karp DR, Quan J, Branch VK, Zhou J, Lian Y, et al. Risk factors for ANA positivity in healthy persons. Arthritis Res Ther 2011; 13(2):R38.
(15) Aringer M, Dörner T, Leuchten N, Johnson SR. Toward new criteria for systemic lupus erythematosus-a standpoint. Lupus 2016; 25(8):805-11.
(16) Danza A, Ruiz-Irastorza G, Khamashta M. El embarazo en las enfermedades autoinmunes sistémicas: mitos, certezas y dudas. Med Clin (Barc) 2016; 147(7):306-12.
(17) Andreoli L, Bertsias GK, Agmon-Levin N, Brown S, Cervera R, Costedoat-Chalumeau N, et al. EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis 2017; 76(3): 476-85.
(18) American College of Rheumatology. Methodology of testing for antinuclear antibodies, 2015:3p. Disponible en: https://www.rheumatology.org/Portals/0/Files/Methodology%20of%20Testing%20Antinuclear%20Antibodies%20Position%20Statement.pdf. Consulta: 3 setiembre 2019.
(19) Bonilla E, Francis L, Allam F, Ogrinc M, Neupane H, Phillips PE, et al. Immunofluorescence microscopy is superior to fluorescent beads for detection of antinuclear antibody reactivity in systemic lupus erythematosus patients. Clin Immunol 2007; 124(1):18-21.
(20) Hira-Kazal R, Shea-Simonds P, Peacock JL, Mather J. How should a district general hospital immunology service screen for anti-nuclear antibodies? An ‘in-the-field’ audit. Clin Exp Immunol 2014; 180:52-7.
(21) Claessens J, Belmondo T, De Langhe E, Westhovens R, Poesen K, Hüe S, et al. Solid phase assays versus automated indirect immunofluorescence for detection of antinuclear antibodies. Autoimmun Rev 2018; 17(6):533-40.
(22) Meroni PL, Bizzaro N, Cavazzana I, Borghi MO, Tincani A. Automated tests of ANA inmunofluorescence as throughput autoantibody detection technology: strengths and limitations. BMC 2014; 12:38.
(23) Bizzaro N, Antico A, Platzgummer S, Tonutti E, Bassetti D, Pesente F, et al. Automated antinuclear immunofluorescence antibody screening: a comparative study of six computer-aided diagnostic systems. Autoimmun Rev 2014; 13(3): 292-8.
(24) Menor Almagro R, Rodríguez JF, Martín-Martínez MA, Rodríguez Valls MJ, Aranda Valera C, de la Iglesia Salgado JL. Asociación entre títulos de anticuerpos antinucleares y conectivopatías sistémicas en una Unidad de Reumatología. Reumatol Clin 2017; 13(3):150-5.
(25) National Committee for Clinical Laboratory Standards (NCCLS). Quality assurance for the indirect Immunofluorescence Test for Autoantibodies to Nuclear Antigen (IF-ANA): approved guideline. (NCCLS document I/LA2-A). Wayne, PA: NCCLS, 1996.
(26) Francescantonio Carvalho PL, de Melo Cruvinel W, Dellavance A, Coelho Andrade LE, Tabiberti BH, von Mühlen CA. IV Consenso Brasileiro para pesquisa de autoanticorpos em células HEp-2. Rev Bras Reumatol 2014; 54(1):44-50.
(27) Brito de Almeida F, Santos Elói SM, Ferreira GA, Pedrosa W, Gradisse J, Costa LC, et al. Detecção de anticorpos antinucleares por imunofluorescência indireta em células HEp-2: definindo a diluição de triagem adequada para o diagnóstico das doenças reumáticas autoimunes. Rev Bras Reumatol 2013; 54(1):13-20.
(28) Kavanaugh A, Tomar R, Reveille J, Solomon DH, Homburger HA. Guidelines for clinical use of the antinuclear antibody test and tests for specific autoantibodies to nuclear antigens. Arch Pathol Lab Med 2000; 124(1):71-81.
(29) Tozzoli R, Bizzaro N, Tonutti E, Villalta D, Bassetti D, Manoni F, et al. Guidelines for the laboratory use of autoantibody tests in the diagnosis and monitoring of autoimmune rheumatic diseases. Am J Clin Pathol 2002; 117(29):316-24.
(30) Chan EK, Damoiseaux J, Carballo OG, Conrad K, de Melo Cruvinel W, Francescantonio PL, et al. Report of the first international consensus on standardized nomenclature of antinuclear antibody Hep-2 cell patterns 2014-2015. Front Immunol 2015; 6:412.
(31) Schouwers S, Bonnet M, Verschueren P, Westhovens R, Blockmans D, Mariën G, et al. Value-added reporting of antinuclear antibody testing by automated indirect immunofluorescence analysis. Clin Chem Lab Med 2014; 52(4):547-51.
(32) Mahler M, Meroni PL, Bossuyt X, Fritzler MJ. Currents concepts and future directions for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies. J Immunol Res 2014:315179.
(33) Bugdaycý G, Polat M. Evaluation of antinuclear antibody (ANA) measurement methods. J Turk Acad Dermatol 2016; 10(2):16102r1.
(34) Chan E, Damoiseaux J, de Melo Cruvinel W, Carballo O, Conred K, Francescantonio P, et al. Report on the second International Consensus on ANA Pattern (ICAP) workshop in Dresden 2015. Lupus 2016; 25(8):797–804.
(35) Meroni P, Schur P. ANA screening: an old test with new recommendations. Ann Rheum Dis 2010; 69(8):1420-2.
(36) Sack U, Conrad K, Csernok E, Frank I, Hiepe F, Krieger T, et al. Autoantibody detection using indirect immunofluorescence on HEp-2 cells. Ann N Y Acad Sci 2009; 1173:166- 73.
(37) Robles Marhuenda A, Ramos Casals, M. Significado clínico de los anticuerpos antinucleares. JANO 2005; 1.578:85-90.
(38) Cabiedes J, Nuñez-Alvarez C. Anticuerpos Antinucleares. Reumatol Clin 2010; 6(4): 224-30.
(39) Hanly J, Urowitz M, Su L, Bae S, Gordon C, Clarke A, et al. Autoantibodies as biomarkers for the prediction of neuropsychiatric events in systemic lupus erythematosus. Ann Rheum Dis 2011; 70(10):1726-32.
(40) Izmirly P, Saxena A, Kim M, Wang D, Sahl S, Llanos C, et al. Maternal and fetal factors associated with mortality and morbidity in a multi-racial/ethnic registry of anti-SSA/Ro-associated cardiac neonatal lupus. Circulation 2011; 124(18):1927-35.
(41) Hoffman I, Peene I, Veys E, De Keyser F. Detection of specific antinuclear reactivities in patients with negative anti-nuclear antibody immunofluorescence screening tests. Clin Chem 2002; 48(12):2171-6.
(42) Blomberg S, Ronnblom L, Wallgren A, Nilsson B, Karlsson-Parra A. Anti-SSA/Ro antibody determination by enzyme-linked immunosorbent assay as a supplement to standard immunofluorescence in antinuclear antibody screening. Scand J Immunol 2000; 51(6):612-7.
(43) Bossuyt X, Luyckx A. Antibodies to extractable nuclear antigens in antinuclear antibody-negative samples. Clin Chem 2005; 51(12):2426-7.