Prediction of development of immune mediated inflammatory diseases with antinuclear antibodies
Heuvel, Hélène van den
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Immune mediated inflammatory diseases (IMIDs) are inflammatory conditions that are currently incurable. The treatment options currently used include corticosteroids, immunosuppressants, and biologicals. As IMIDs can cause significant tissue damage when untreated, early diagnosis is essential. This proves to be a challenge, as clinical manifestations vary largely between patients. One of the potential diagnostic tools could be antinuclear antibodies (ANAs). This is a group of various autoantibodies that target nuclear molecules. Some of these ANAs are exclusively associated with particular IMIDs. In addition, previous literature has demonstrated ANAs are present years prior to clinical diagnosis of the IMID. In light of these findings, the current thesis aims to explore the predictive value of positive ANA screening tests and specific ANA tests for development of IMIDs within six years following a positive ANA screening test or specific ANA test. In order to achieve the aim, the electronic health records of 1030 patients were analyzed to find new IMID diagnoses using a text mining algorithm. These patients were retrieved from a study conducted in 2014 (Otten et al.). In their study, the researchers aimed to evaluate the current strategy concerning ANA tests for the purpose of confirming IMID diagnoses. Based on their data, the predictive value of the ANA test results for future IMID development was explored. The findings of the current study demonstrate only a small proportion of the patients that were considered to be at high risk of future IMID development actually developed an IMID in the six years following the initial ANA tests. Nevertheless, the patients that developed an IMID in the years after the ANA tests were conducted were more likely to have positive ANA screening tests and positive specific ANA tests compared to patients with similar pretest probability for IMID development that did not develop an IMID. Hence, the findings suggest ANA tests could be used as predictors for IMID development in the near future. Especially in patients that have a high pretest probability of developing a future IMID based on clinical guidance, positive ANA test results could serve as a diagnostic tool.