[Clinical significance of antinuclear antibodies in progressive systemic sclerosis]. / Significato clinico degli anticorpi antinucleari nella sclerosi sistemica progressiva.

ABSTRACT

Indirect immunofluorescence (IIF) was used to detect antinuclear antibodies (ANA) in 42 clinical cases. In each case cryostatic rat kidney slices and cultivated HEp-2 cells were used as substrates. Clinical diagnoses were as follow Progressive Systemic Sclerosis (PSS) 25 cases, of which 8 were acrosclerotic, 8 diffuse, 5 CREST syndrome, 1 overlap PSS + Systemic Lupus Erythematosus (SLE) and 3 PSS + myopathy; Localised scleroderma (morphea) 3 cases; Mixed Connective Tissue Disease (MCTD) 3 cases; "Idiopathic" Raynaud's Disease (RD) 4 cases; Dermatomyositis (DM) 2 cases (1 paraneoplastic); SLE 1 case; Unclassifiable Connective Tissue Disease (UCTD) 4 cases. The ANA-positive cases identified by the traditional technique were divided according to pattern into 4 categories homogeneous, peripheral, speckled, nucleolar. In contrast those identified using HEp-2 cells were divided into 9 pattern groups (nuclear type) centromere, fine speckled, coarse speckled, diffusely grainy, homogeneous (nucleolar type) speckled, clumpy, homogeneous. The results demonstrated a higher general incidence of positivity with HEp-2 cells and confirmed the close connection between Anticentromere ANA and CREST syndrome. A similarly close connection was noted between MCTD and both nuclear diffusely grainy and nucleolar speckled patterns. A fairly clear connection was also noted between acrosclerotic or diffuse SSP and a fine speckled nuclear pattern. It is felt that ANA tests using IFI on HEp-2 cells should lead to significant progress in the field of diagnosis and prognosis and the study of PSS subsets.