266 - L’applicazione di un protocollo combinato per la richiesta e l’esecuzione dei test autoanticorpali migliora l’efficacia clinica nella diagnosi delle malattie reumatiche autoimmuni
Autore/i: M. Tampoia, V. Brescia, A. Fontana, A. Zucano, G. Lapadula, R. Numo, N. Pansini.
Rivista: RIMeL - IJLaM, Vol. 1, N. 4, 2005 (MAF Servizi srl ed.)
The application of a combined protocol for the request
and the execution of autoantibodies improves
the clinical effectiveness in the diagnosis of the autoimmune
rheumatic diseases.
Background. The tests of greater meaning for the diagnosis
of the autoimmune rheumatic diseases include anti-nuclear
antibodies (ANA), anti-extractable nuclear antigens antibodies
(ENA) and anti-double stranded DNA antibodies (antidsDNA).
As the request of such tests is notably increased in
the last years, our objective was to apply a protocol for the
appropriate use of laboratory testing according to the most
recent international guidelines for the diagnosis of the autoimmune
rheumatic diseases, and to appraise the results in
terms of clinical effectiveness and economic efficiency.
Methods. Beginning from January 2004, a diagnostic protocol
was applied for the execution of second level tests (anti-
ENA and anti-dsDNA) according to the clinical data supplied
on 685 consecutive requests for antibody testing and
the results of first level tests (ANA). The patients were then
clinically followed for 12 months and the appropriateness
of the protocol was evaluated.
Results. The introduction of the protocol enabled a significant
reduction in the number of second level tests (27.9%
vs 49.5% for anti-ENA; 27.5% vs 56.6% for anti-dsDNA).
At the end of the follow-up, none of the 163 patients who
were negative to first level tests and who had no symptoms
of rheumatic disease, to whom second level tests were requested
but not performed, were found to be affected by
an autoimmune rheumatic disease. Conversely, in 77 of the
85 (90.5%) who were positive to the second level tests, the
presence or the development of an autoimmune rheumatic
disease was clinically confirmed.
Conclusions. ...