Artrit ve Artritin İmmünolojik Tanısında Otoantikorlar
Özet
Sistemik otoimmün romatizmal hastalıklar, tanı, prognoz, hasta yönetimde kritik rol oynayan çeşitli otoantikorlarla ilişkilidir. Bazı otoantikorların klinik önemi iyi tanımlanmıştır, fakat henüz çok iyi karakterize edilememiş, araştırma aşamasında olan otoantikorlar da mevcuttur. Otoantikorların uygun laboratuvar yöntemi ile tanımlanması, standart bir şekilde raporlanması, klinik olarak ilişkilerinin ortaya konması, hastalığın tanısı, prognozu ve tedavi takibinde doğru bir şekilde kullanılması hasta yönetiminde son derece önemlidir. Bu noktada laboratuvar uzmanı ve klinisyen işbirliği son derece önemlidir. Bu bölümde, artrite neden olan sistemik otoimmün romatizmal hastalıklar ve immünolojik tanısında kullanılan otoantikorlar özetlenmiştir.
Systemic autoimmune rheumatic diseases are associated with various autoantibodies that play a critical role in diagnosis, prognosis, and patient management. The clinical significance of some autoantibodies is well defined, but there are also autoantibodies that have not yet been fully characterized and are still under investigation. The identification of autoantibodies using appropriate laboratory methods, their standardized reporting, the establishment of their clinical correlations and their accurate use in disease diagnosis, prognosis, and treatment monitoring are extremely important in patient management. In this regard, collaboration between laboratory specialists and clinicians is crucial. This section provides an overview of systemic autoimmune rheumatic diseases that cause arthritis and the autoantibodies used in their immunological diagnosis.
Referanslar
Tolerans ve Otoimmün Hastalık, In: Tıbbi Mikrobiyoloji ve İmmünoloji, Levinson W, Chin-Hong P, Joyce EA, Nussbaum J, Schwartz B. (Çeviri Ed. Berrin Esen, Burçin Şener), (16. Baskı), Ankara: Güneş Tıp Kitapevleri, sy: 578-587; 2022.
Abbas AK, Lichtman AH, Pillai S (eds). Basic Immunology Functions and Disorders of the Immune System. (6th Edition). Philadelphia: Elsevier Saunders; 2020.
Abbas AK, Lichtman AH, Pillai S (eds). Cellular and Molecular Immunology. (8th Edition). Philadelphia: Elsevier Saunders; 2015.
Smatti MK, Cyprian FS, Nasrallah GK, et al. Viruses and Autoimmunity: A Review on the Potential Interaction and Molecular Mechanisms. Viruses. 2019;11(8):762. doi: 10.3390/v11080762.
Irure-Ventura J, López-Hoyos M. The Past, Present, and Future in Antinuclear Antibodies (ANA). Diagnostics (Basel). 2022;12(3):647. doi: 10.3390/diagnostics12030647.
Aringer M, Johnson SR. Classifying and diagnosing systemic lupus erythematosus in the 21st century. Rheumatology (Oxford). 2020;59(Suppl5):v4-v11. doi: 10.1093/rheumatology/keaa379.
Bossuyt X, Fieuws S. Detection of antinuclear antibodies: added value of solid phase assay? Annals of the Rheumatic Diseases.2014;73(3):e10. doi: 10.1136/annrheumdis-2013-204793.
Orme ME, Andalucia C, Sjolander S, et al. A comparison of a fluorescence enzyme immunoassay vs. indirect immunofluorescence for initial screening of connective tissue diseases: systematic literature review and meta-analysis of diagnostic test accuracy studies. Best Practice & Research: Clinical Rheumatology. 2018;32(4):521–534. doi: 10.1016/j.berh.2019.03.005.
Bizzaro N. Can solid-phase assays replace immunofluorescence for ANA screening? Annals of the Rheumatic Diseases. 2020;79(3):e32. doi: 10.1136/annrheumdis-2018-214805.
Bossuyt X, De Langhe E, Borghi MO, et al. Understanding and interpreting antinuclear antibody tests in systemic rheumatic diseases. Nature Reviews Rheumatology. 2020;16(12):715-726. doi: 10.1038/s41584-020-00522-w.
Bonroy C, Vercammen M, Fierz W, et al. European Federation of Laboratory Medicine (EFLM) Working Group “Autoimmunity Testing,” the European Autoimmune Standardization Initiative (EASI) and International Consensus on Antinuclear Antibody Patterns (ICAP). Detection of antinuclear antibodies: recommendations from EFLM, EASI and ICAP. Clinical Chemistry and Laboratory Medicine. 2023;61(7):1167-1198. doi: 10.1515/cclm-2023-0209.
Pisetsky DS, Spencer DM, Lipsky PE, et al. Assay variation in the detection of antinuclear antibodies in the sera of patients with established SLE. Annals of the Rheumatic Diseases. 2018;77(6):911-913. doi: 10.1136/annrheumdis-2017-212599.
Stuhlmüller B, Schneider U, González-González JB, et al. Disease Specific Autoantibodies in Idiopathic Inflammatory Myopathies. Frontiers in Neurology. 2019;10:438. doi: 10.3389/fneur.2019.00438.
Op De Beeck K, Vermeersch P, Verschueren P, et al. Detection of antinuclear antibodies by indirect immunofluorescence and by solid phase assay. Autoimmunity Reviews. 2011;10(12):801-808. doi: 10.1016/j.autrev.2011.06.005.
Bossuyt X, Luyckx A. Antibodies to extractable nuclear antigens in antinuclear antibody-negative samples. Clinical Chemistry. 2005;51(12):2426-2427. doi: 10.1373/clinchem.2005.058552.
Mahler M, Kessenbrock K, Szmyrka M, et al. International multicenter evaluation of autoantibodies to ribosomal P proteins. Clinical and Vaccine Immunology. 2006;13(1):77-83. doi: 10.1128/CVI.13.1.77-83.2006.
Ceribelli A, Fredi M, Taraborelli M, et al. Anti-MJ/NXP-2 autoantibody specificity in a cohort of adult Italian patients with polymyositis/dermatomyositis. Arthritis Research & Therapy. 2012;14(2):R97. doi: 10.1186/ar3822.
Fritzler MJ, Choi MY, Mahler M. The Antinuclear Antibody Test in the Diagnosis of Antisynthetase Syndrome and Other Autoimmune Myopathies. The Journal of Rheumatology. 2018;45(3):444-445. doi: 10.3899/jrheum.
Damoiseaux J, Chan EK. Response to: 'The utility of the HEp-2000 antinuclear antibody substrate' by Lee et al. Annals of the Rheumatic Diseases. 2020;79(6):e68. doi: 10.1136/annrheumdis-2019-215610.
Lee AYS, Beroukas D, Roberts-Thomson PJ. Utility of the HEp-2000 antinuclear antibody substrate. Annals of the Rheumatic Diseases. 2020;79(6):e67. doi: 10.1136/annrheumdis-2019-215519.
https://www.anapatterns.org/ ((Erişim tarihi: 10.05.2026).
von Mühlen CA, Garcia-De La Torre I, Infantino M, et al. How to report the antinuclear antibodies (anti-cell antibodies) test on HEp-2 cells: guidelines from the ICAP initiative. Immunologic Research. 2021;69(6):594-608. doi: 10.1007/s12026-021-09233-0.
Damoiseaux J, Andrade LEC, Carballo OG, et al. Clinical relevance of HEp-2 indirect immunofluorescent patterns: the International Consensus on ANA patterns (ICAP) perspective. Annals of the Rheumatic Diseases. 2019;78(7):879-889. doi: 10.1136/annrheumdis-2018-214436.
Andrade LEC, Klotz W, Herold M, et al. Reflecting on a decade of the international consensus on ANA patterns (ICAP): Accomplishments and challenges from the perspective of the 7th ICAP workshop. Autoimmunity Reviews. 2024;23(9):103608. doi: 10.1016/j.autrev.2024.103608.
Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis & Rheumatology. 2019;71(9):1400-1412. doi: 10.1002/art.40930.
Aringer M. EULAR/ACR classification criteria for SLE. Seminars in Arthritis andRheumatism. 2019;49(3S):S14-S17. doi:10.1016/j.semarthrit.2019.09.009.
Shiboski CH, Shiboski SC, Seror R, et al. International Sjögren's Syndrome Criteria Working Group. 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts. Arthritis & Rheumatology. 2017;69(1):35-45. doi: 10.1002/art.39859.
André F, Böckle BC. Sjögren's syndrome. Journal der Deutschen Dermatologischen Gesellschaft. 2022;20(7):980-1002. doi: 10.1111/ddg.14823.
van den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis and Rheumatism. 2013;65(11):2737-2747. doi: 10.1002/art.38098.
Wollheim FA. Classification of systemic sclerosis. Visions and reality. Rheumatology (Oxford). 2005;44(10):1212-1216. doi: 10.1093/rheumatology/keh671.
Mehra S, Walker J, Patterson K, et al. Autoantibodies in systemic sclerosis. Autoimmunity Reviews. 2013;12(3):340-354. doi: 10.1016/j.autrev.2012.05.011.
Cutolo M, Soldano S, Smith V. Pathophysiology of systemic sclerosis: current understanding and new insights. Expert Review of Clinical Immunology.2019;15(7):753-764. doi: 10.1080/1744666X.2019.1614915.
Koenig M, Dieudé M, Senécal JL. Predictive value of antinuclear autoantibodies: the lessons of the systemic sclerosis autoantibodies. Autoimmunity Reviews. 2008;7(8):588-593. doi: 10.1016/j.autrev.2008.06.010.
Almaabdi K, Ahmad Z, Johnson SR. Advanced Autoantibody Testing in Systemic Sclerosis. Diagnostics (Basel). 2023;13(5):851. doi: 10.3390/diagnostics13050851.
Lundberg IE, Fujimoto M, Vencovsky J, et al. Idiopathic inflammatory myopathies. Nature Reviews Disease Primers. 2021;7(1):87. doi: 10.1038/s41572-021-00325-7.
Lundberg IE, Fujimoto M, Vencovsky J, et al. Idiopathic inflammatory myopathies. Nature Reviews Disease Primers. 2021;7(1):86. doi: 10.1038/s41572-021-00321-x.
Gono T, Kuwana M. Current understanding and recent advances in myositis-specific and associated autoantibodies detected in patients with dermatomyositis. Expert Review of Clinical Immunology. 2020;16(1):79-89. doi: 10.1080/1744666X.2019.1699059.
Stuhlmüller B, Schneider U, González-González JB, et al. Disease Specific Autoantibodies in Idiopathic Inflammatory Myopathies. Frontiers in Neurology. 2019;10:438. doi: 10.3389/fneur.2019.00438.
Antunes M, Scirè CA, Talarico R, et al. Undifferentiated connective tissue disease: state of the art on clinical practice guidelines. RMD Open. Rheumatic & Musculoskeletal Diaeases. 2019;4(Suppl 1):e000786. doi: 10.1136/rmdopen-2018-000786.
Mosca M, Tani C, Neri C, et al. Undifferentiated connective tissue diseases (UCTD). Autoimmunity Reviews. 2006;6(1):1-4. doi: 10.1016/j.autrev.2006.03.004.
Fritzler MJ, Martinez-Prat L, Choi MY, et al. The Utilization of Autoantibodies in Approaches to Precision Health. Frontiers in Immunology. 2018;9:2682. doi: 10.3389/fimmu.2018.02682.
Song YW, Kang EH. Autoantibodies in rheumatoid arthritis: rheumatoid factors and anticitrullinated protein antibodies. QJM: An International Journal of Medicine. 2010;103(3):139-146. doi: 10.1093/qjmed/hcp165.
de Brito Rocha S, Baldo DC, Andrade LEC. Clinical and pathophysiologic relevance of autoantibodies in rheumatoid arthritis. Advances in Rheumatology. 2019;59(1):2. doi: 10.1186/s42358-018-0042-8.
Martin J, Petryayeva E, Khan WI. Autoantibodies in Common Connective Tissue Diseases: A Primer for Laboratory Professionals. Journal of Applied Laboratory Medicine. 2022;7(1):114-136. doi: 10.1093/jalm/jfab131.
