Association of ANA seropositivity with RF, CRP, Brucellosis test in patients
with SLE, a compression between immunofluorescence technique and
latex agglutination
Introduction
SLE (Systemic Lupus Erythematosus) was a multiple system of
autoimmune disorder with a broad spectrum of clinical presentations.
1 There is a peak age of onset among young women
between the late teens and early 40s and a female to male ratio
of 9:1. Ethnic groups such as those with African or Asian
ancestry were higher at risk of developing the disorder and it
may be more severe compared to Caucasian patients. Systemic
Lupus Erythematosus (SLE) was a chronic disease that may be
life-threatening when major organs are affected but more
commonly results in chronic debilitating ill health. There was
no single cause of SLE has been identified though factors such
as sunlight and drugs may precipitate the condition and there
is a complex genetic basis.2
SLE was represented by immune dysregulation resulting
in the production of autoantibodies such as ANA, that make
generation of circulating immune complexes, and induce activation
of the complement system.3 A positive ANA result is
consistent with SLE, and it is extremely rare for them to have a
negative ANA.4 The presence of ANA in SLE patients is both a
diagnostic and a prognostic marker.5
Antinuclear antibody (ANA) tests were usually performed
on patients’ serum with various connective tissue diseases,
especially in systemic lupus erythematosus (SLE), for diagnostic
evidence, significance prognosis, and management of
therapy. The higher titer level of ANA is found in active SLE
and the presence of these antibodies was the second most
common manifestations of SLE.
Immunofluorescence (IF) test was the best test of choice for
screening for the presence of ANA since it detects 95–100% of
active SLE cases. ANA has been well documented in many different
diseases status as well as in healthy relatives of SLE
patients. The incidence of a positive ANA has been varied with
in each diseases.6 Rheumatoid factors (RF) were antibodies that
react with the individual’s own immunoglobulin.7 These antibodies
were directed against the Fc region of the IgG molecule.
Rheumatoid Factor can be detected in the serum of the
majority of patients with rheumatoid arthritis and is important
for the diagnosis and prognosis of those patients with higher
concentrations.8 Rheumatoid factors was not specific disease
that can present in a lower frequencies in multiple other autoimmune
disorders, chronic inflammation and normal individuals.9
C-reactive protein (CRP) was special type of protein produced
by liver organ has been only present during the episodes
of acute inflammation. The most important role of CRP was that
is interaction with complement system, which is one of the
immunologic defense mechanisms of the body. C-reactive protein
was a protein produced in the liver by the pro-inflammatory
cytokines tumor necrosis factor alpha, interleukin-6, and interleukin-
1B. Since CRP test was considered as general test, the
positive CRP test may be indicative in any number of conditions;
cancer, rheumatoid arthritis, tuberculosis, rheumatic fever, myocardial
infarction, pneumococcal pneumonia, or SLE.10.
Malta fever is a bacterial disease caused by bacteria
infection known as Brucella abortus.11 Serological test confirm
the diagnosis when symptoms are present. Rose Bengal
test was usually the serological test that was recommended
used for disease screening and in management of patients
with finding a positive test even absence of symptoms, the
positive test should be discussed with other inflammatory
disease or other microbe infection, because Rose Bengal test
is positive in 80% of patient and negative in 20% of patient.12
Auto immunity and brucellosis is not clear and there are very
limited publications about this interaction. Anti-nuclear
