The “constellation” of anti-nuclear autoanibodies between auto-reactivity and autoimmune diseases. Proposal of rationale use of the available diagnostic tests

Abstract The production of anti-nuclear antibody (ANA) can be observed, more commonly, in the context of intense immunophlogistic reactions, as autoimmune serologic epiphenomenon, and, less frequently, in the development of systemic autoimmune diseases. The possibility to detect and to assay specific antibodies for many different nuclear antigens is relatively recent; therefore, until now, correlations between patterns and concentrations of autoantibody detected in the immunopathology laboratory and final diagnosis made in each patient have been performed incompletely. We have analyzed retrospectively sera sent to the pathology laboratory from different hospital units and examined for the presence of ANA, AMA, ASMA, APCA, KLM, nDNA and anti-ENA antibodies. In each patient, the positive autoantibody patterns were compared with the diagnosis formulated by the clinicians. We observed a low (12.5%) percentage of sera positive for ANA, AMA, ASMA, APCA or anti-KLM antibodies in the reviewed (2.192) cases; this observation can be due to the habit to require laboratory tests on a routine basis, rather than to define specific clinical suspicions. On the basis of the correlations between laboratory tests that have been carried out and the related clinical diagnoses, we propose a diagnostic protocol for a rational, useful and economically sustainable use of the available diagnostic tests to detect autoantibodies specific for specific nuclear antigens