AC-4 - Fine Speckled
Descrição
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.
Referências
Betteridge Z, McHugh N. Myositis-specific autoantibodies: an important tool to support diagnosis of myositis. J Intern Med 2016;280:8–23.
Bossuyt X, Frans J, Hendrickx A, et al. Detection of anti-SSA antibodies by indirect immunofluorescence. Clin Chem 2004;50:2361–9.
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.