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Q J Med 2004; 97: 303-308
QJM vol. 97 no. 5 (c) Association of Physicians 2004; all rights reserved.

Commentary

Antinuclear antibody-negative lupus as a distinct diagnostic entity—does it no longer exist?

L.S. Cross, A. Aslam and S.A. Misbah

From the Department of Clinical Immunology, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK

The first 150 words of the full text of this article appear below.


   Introduction
 
Systemic lupus erythematosus (SLE) is a multi-system autoimmune disorder with protean clinical presentations. Historically, Biett reported the first case of lupus erythematosus in 1833, and Kaposi later described the systemic form in 1872,1 but the varied presentation of this illness has made it a challenging diagnosis for clinicians. The difficulties in the diagnosis of SLE were considerably eased by the demonstration of antinuclear antibodies (ANA) as a marker of lupus, initially in the form of LE cells2 and later by indirect immunofluorescence.3 Since then, ANA positivity has become an important diagnostic criterion for the diagnosis of SLE and officially recognised as such by its inclusion in the American College of Rheumatology's criteria for the classification of this disorder.4,5

The concept of ANA-negative lupus was first mooted by Koller et al. in 1976, with their description of five patients who were ANA-negative despite having clinical features consistent with SLE.6 Cutaneous features, . . . [Full Text of this Article]


   Literature search
 

   Results
 

   Influence of antigenic deficiency in testing substrate on ANA status
 

   Concurrent immunosuppressive treatment
 

   Proteinuria
 

   Limitations of this literature review
 

   Concluding remarks
 

Address correspondence to: Dr S.A. Misbah, Department of Clinical Immunology, Oxford Radcliffe Hospitals NHS Trust, Oxford OX3 9DU. e-mail: siraj.misbah@orh.nhs.uk


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