AC-4 - Fine Speckled

Fine tiny speckles across all nucleoplasm. The nucleoli may be stained or not stained. Mitotic cells (metaphase, anaphase, and telophase) have the chromatin mass not stained. e.g. anti-SS-A/Ro, anti-SS-B/La.
Associação Antigênica
SS-A/Ro, SS-B/La, Mi-2, TIF1?, TIF1?, Ku.
Doença Associada
SjS, SLE, dermatomyositis.
Relevância Clínica (Primeiro Nível)
Present to a varying degree in distinct SARD, in particular SjS, SLE, subacute cutaneous lupus erythematosus, neonatal lupus erythematosus, congenital heart block, DM, SSc, and SSc-AIM overlap syndrome.
If SjS, SLE, subacute cutaneous lupus erythematosus, neonatal lupus erythymatosus, or congenital heart block is clinically suspected, it is recommended to perform follow-up tests for anti-SS-A/Ro (Ro60) and anti-SS-B/La antibodies; in most laboratories these antigens are included in the routine ENA profile.
Autoantibodies to SS-A/Ro are part of the classification criteria for SjS (the criteria do not distinguish between Ro60 and Ro52/TRIM21).
If SSc, AIM, or to a lesser extend SLE, is clinically suspected, it is recommended to perform follow-up tests for detecting autoantibodies to Mi-2, TIF1?, and Ku; these antigens are typically included in disease specific immunoassays (i.e., inflammatory myopathy profile).
Autoantibodies to Mi-2 and TIF1? are associated with DM; autoantibodies to TIF1? in patients with DM, although rare in the overall AC-4 pattern, is strongly associated with malignancy in old patients.
Autoantibodies to Ku are associated with SSc-AIM and SLE-SSc-AIM overlap syndromes.
Anti-SS-A/Ro (Ro60) and AIM-specific autoantibodies may be undetected in HEp-2 IIFA-screening.
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Conrad K, Scho?ssler W, Hiepe F. Autoantibodies in systemic autoimmune diseases: a diagnostic reference. 2. 3th edn. Autoantigens autoantibodies autoimmunity, 2015.

Shiboski CH, Shiboski SC, Seror R, et al. American College of Rheumatology/ European League against rheumatism classification criteria for primary Sjo?gren’s syndrome: a consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis 2016;2017:9–16.

Trallero-Aragua?s E, Rodrigo-Penda?s JA?, Selva-O’Callaghan A, et al. Usefulness of anti-p155 autoantibody for diagnosing cancer-associated dermatomyositis: a systematic review and meta-analysis. Arthritis Rheum 2012;64:523–32.