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Normal titer ranges for antinuclear antibodies is age-dependent:
The pattern of immunofluorescent staining should be reported along with the titer. Homogeneous staining indicates antibodies to histones and deoxyribonucleoproteins. A speckled pattern is found with antibodies against ENA, a group of saline-soluble antigens that include nonhistone proteins and nuclear ribonucleoprotein (RNP). Peripheral staining indicates double-stranded (ds) DNA, rheumatoid factor, and antiphospholipid. Nucleolar staining is positive for anti-nucleolar RNP, a result specific for the autoimmune skin disorder scleroderma. Specific staining of centromeres is indicative of a systemic sclerosis varient known as CREST syndrome. More than 95% of people with SLE have a positive ANA test. Scleroderma has a 60–71% positive rate; Sjögren's disease, 50–60%, and rheumatoid arthritis, 25–30%. Serum that tests positive for ANA can be further tested by EIA with specific antigens to confirm a diagnosis. Positive tests for anti-double-stranded (ds) DNA or anti-Sm
The titer in a normal sample is < 1:40. A positive result is typified by granular staining in the cytoplasm of all tissue types in the commercial multiblock. Antimitochondrial antibody tests are positive in about 94% of patients with primary biliary cirrhosis (PBC), with typical titers of > 1:160, and in 25% of patients with chronic hepatic cirrhosis. Positive samples should be screened by EIA for antibodies specific to the M2 antigen to confirm the diagnosis of PBC.
Reference levels will be dependent on the type of commercial EIA kit used and should be independently established in each laboratory. Antiphospholipid antibodies occur with a prevalence of 40% in patients with SLE. Over 75% of patients presenting with spontaneous abortions were positive for only IgG antibodies, while patients with thromboses had mainly IgM antibodies. IgG and IgM antibodies were found simultaneously in 31% of patients with Sjögren's syndrome.
Author Info: Patricia L. Bounds Ph.D., The Gale Group Inc., Gale, Detroit, Gale Encyclopedia of Nursing and Allied Health, 2002
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