Antinuclear Antibodies (ANA) Save

With respect, Dr. Cush, your comments regarding ANA positivity and titer levels are not consistent with the 2019 EULAR/ACR clinical criteria for SLE. As you know, ANA positivity is required for SLE, but the criteria are clear that positivity can occur once EVER, with a titer equal to or greater than 1:80. By perpetuating the misconception that ANAs of 1:80 or 1:160 are meaningless, the under-diagnosis of indolent, atypical phenotypes (e.g. late-onset SLE) will continue. Late-onset SLE patients are being missed because the rheumatological community has failed to embrace the current thinking. Late-onset SLE is recognized to have a more subtle presentation, with less impressive antibody profiles, and diagnosis is often delayed or missed entirely because of outdated ideology and practices. Despite generally lower disease activity levels, late-onset SLE patients have higher accrued organ damage and mortality rates because of these delays. The EULAR/ACR clinical criteria have been rigorously formulated and validated; why, then, does it take so long for them to be utilized? Please reference the current EULAR/ACR criteria in your podcasts. Thank-you for the excellent work you do!

Again with respect, a few more points: The ANA "diffuse pattern" referenced in the video is no longer the preferred term. The current standardized ICAP nomenclature uses "homogenous" (AC-1) rather than "diffuse". The ICAP initiative was specifically developed to promote harmonization of staining pattern nomenclature and to address the problem of inconsistent terminology. On a separate note: The "homogeneous" (AC-1) pattern is the second most common in SLE, occurring in approximately 35% of SLE patients. "Fine speckled" (AC-4) and "large speckled" (AC-5), together comprise approximately 52% of SLE patients. These patterns increase suspicion in SLE workups, even in the absence of more specific SLE antibodies like dsDNA and anti-Sm. Lastly: In the absence of dsDNA or anti-SM (as in late-onset SLE), esp. if C3 & C4 are generally stable, monitoring SLE disease activity can be challenging. Some studies demonstrate that ANA titers decrease significantly in patients whose disease activity decreases, and ANA titers are lower in patients in remission compared to patients with intermediate or active disease activity. Monitoring ANA titers could potentially be useful in these cases.