NeurologicdisorderSeizures,psychosis,myelitis,orneuropathy,intheabsenceofoffendingdrugsorotherknowncauses
LeukopeniaorLeukopenia—<4.0× 109cells/L(4000cells/mm3)totalontwoormoreoccasions,or lymphopeniaLymphopenia—<1.5× 109cells/L(1500cells/mm3)ontwoormoreoccasions *Thisclassificationwasinitiallyproposedin1997bytheAmericanCollegeofRheumatologyforthepurposeofidentifyingpatientsinclinicalstudies.Ithasbeenupdatedin2012bytheSystemicLupusInternationalCollaboratingClinics.ApatientisclassifiedashavingSLEiffouroftheclinicalandimmunologiccriteriaarepresentatanytime(notnecessarilyconcurrently),includingatleastoneclinicalandoneimmunologiccriterion.Somedetailshavebeenomittedfromthetable.ModifiedfromPetriM,OrbaiAM,AlarcónGS,etal:DerivationandvalidationoftheSystemicLupusInternationalCollaboratingClinicsclassificationcriteriaforsystemiclupuserythematosus.Arthritis Rheum 64:2677,2012.
http://ebooksmedicine.net “Generic”anti-nuclearantibodies(ANAs),whichmayreactagainstmanynuclearantigens,arepositiveinalargefractionofpatientswithSLEbutalsoarepositiveinotherautoimmunediseases.% positive referstotheapproximate%ofpatientswhotestpositiveforeachantibody.TablecompiledwiththeassistanceofDr.AntonyRosen,JohnsHopkinsUniversity,andDr.AndrewGross,UniversityofCaliforniaSanFrancisco.
and management of patients with SLE, these autoantibodies are of major pathogenic significance, as, for example, in the immune complex–mediated glomerulonephritis so typical of this disease. Autoantibodies also are found in other autoimmune diseases, many of which tend to be associated with specific types of autoantibodies (
Table 5.11
ANAs can be grouped into four categories: (1) antibodies to DNA, (2) antibodies to histones, (3) antibodies to nonhistone proteins bound to RNA, and (4) antibodies to nucleolar antigens. The most widely used method for detecting ANAs is indirect immunofluorescence, which can identify antibodies that bind to a variety of nuclear antigens, including DNA, RNA, and proteins (collectively called generic ANAs). The pattern of nuclear fluorescence suggests the type of antibody present in the patient’s serum. Several basic patterns are recognized (
Fig. 5.22 homogeneous or diffuse staining pattern usually reflects the presence of antibodies to chromatin, histones, and, occasionally, double-stranded DNA.
rim or peripheral staining pattern is most often indicative of antibodies to double-stranded DNA and sometimes to nuclear envelope proteins.
centromeric pattern is indicative of antibodies specific for centromeres. This pattern is often observed in patients with systemic sclerosis.
speckled pattern refers to the presence of uniform or variable-sized speckles. This is one of the most commonly observed patterns of fluorescence and therefore the least specific. It reflects the presence of antibodies to non-DNA nuclear constituents such as Sm antigen, ribonucleoprotein, and SS-A and SS-B reactive antigens.
•A nucleolar pattern refers to the presence of a few discrete spots of fluorescence within the nucleus and represents antibodies to RNA. This pattern is reported most often in patients with systemic sclerosis.