Abstract：
BACKGROUND: Antinuclear antibodies (ANA) detected in juvenile idiopathic arthritis (JIA) sera are considered to be a biomarker for JIA-related uveitis. There is an unclear consensus on the screening dilutions of ANA as detected by the HEp-2 indirect immunofluorescence assay (IFA) that should be used when predicting the risk of uveitis in JIA. The primary aim of this systematic review and meta-analysis was to summarize the evidence regarding ANA prevalence and performance in JIA and JIA-associated uveitis.
METHODS: A search of five databases identified 1766 abstracts, using the search terms juvenile idiopathic arthritis; pediatric; sensitivity or diagnostic; and ANA. Studies that met inclusion/exclusion criteria were analyzed for the proportion of JIA patients with a positive ANA. Forest plots and pooled estimates were generated for the proportion of JIA patients and those with uveitis who were positive for ANA stratified by screening dilution. Study heterogeneity was also assessed.
RESULTS: Twenty-eight studies met inclusion criteria yielding 6250 unique patients; 5902 had JIA and 348 were healthy controls or were known to have other autoimmune diseases. The most reported IFA serum screening dilution was ≥1:80, representing 41.9% of patients and this screening dilution had the highest proportion of JIA ANA positivity (41.0%; 95% CI 25.0%-57.0%). ANA screening for JIA uveitis had a sensitivity and specificity of ANA at ≥1:40 of 75% (95% CI 46%-100%) and 66% (95% CI 39%-93%), respectively. There was significant study heterogeneity across both JIA subtypes and ANA titres.
CONCLUSIONS: Although there was a large variation of ANA IFA screening dilutions used for investigation of JIA, the most common dilution was 1:80. The current literature has several important deficiencies that are identified in this review requiring additional studies to inform the ANA screening dilutions of clinical value in JIA and JIA-associated uveitis.
METHODS: A search of five databases identified 1766 abstracts, using the search terms juvenile idiopathic arthritis; pediatric; sensitivity or diagnostic; and ANA. Studies that met inclusion/exclusion criteria were analyzed for the proportion of JIA patients with a positive ANA. Forest plots and pooled estimates were generated for the proportion of JIA patients and those with uveitis who were positive for ANA stratified by screening dilution. Study heterogeneity was also assessed.
RESULTS: Twenty-eight studies met inclusion criteria yielding 6250 unique patients; 5902 had JIA and 348 were healthy controls or were known to have other autoimmune diseases. The most reported IFA serum screening dilution was ≥1:80, representing 41.9% of patients and this screening dilution had the highest proportion of JIA ANA positivity (41.0%; 95% CI 25.0%-57.0%). ANA screening for JIA uveitis had a sensitivity and specificity of ANA at ≥1:40 of 75% (95% CI 46%-100%) and 66% (95% CI 39%-93%), respectively. There was significant study heterogeneity across both JIA subtypes and ANA titres.
CONCLUSIONS: Although there was a large variation of ANA IFA screening dilutions used for investigation of JIA, the most common dilution was 1:80. The current literature has several important deficiencies that are identified in this review requiring additional studies to inform the ANA screening dilutions of clinical value in JIA and JIA-associated uveitis.
摘要：
背景：在幼年特发性关节炎（JIA）血清中检测到的抗核抗体（ANA）被认为是JIA相关葡萄膜炎的生物标志物。对于HEp-2间接免疫荧光测定法（IFA）检测到的ANA的筛选稀释度，目前尚无共识，该方法应用于预测JIA中葡萄膜炎的风险。本系统评价和荟萃分析的主要目的是总结有关JIA和JIA相关葡萄膜炎的ANA患病率和表现的证据。
方法：对五个数据库的搜索确定了1766个摘要，使用搜索词幼年特发性关节炎；儿科；敏感性或诊断性；和ANA。分析符合纳入/排除标准的研究中ANA阳性的JIA患者的比例。通过筛选稀释对ANA呈阳性的JIA患者和葡萄膜炎患者的比例进行了森林图和汇总估计。还评估了研究异质性。
结果：28项研究符合纳入标准，产生6250名独特患者；5902名患有JIA，348名是健康对照或已知患有其他自身免疫性疾病。报告最多的IFA血清筛查稀释度≥1：80，占41.9％的患者，该筛查稀释度的JIAANA阳性比例最高（41.0％；95％CI25.0％-57.0％）。ANA筛查JIA葡萄膜炎的敏感性和特异性在≥1:40时为75％（95％CI46％-100％）和66％（95％CI39％-93％），分别。JIA亚型和ANA滴度均存在显著的研究异质性。
结论：尽管用于调查JIA的ANAIFA筛选稀释度存在很大差异，最常见的稀释是1:80.目前的文献有几个重要的缺陷，在这篇综述中发现，需要额外的研究来告知ANA筛查稀释物在JIA和JIA相关葡萄膜炎中的临床价值。
方法：对五个数据库的搜索确定了1766个摘要，使用搜索词幼年特发性关节炎；儿科；敏感性或诊断性；和ANA。分析符合纳入/排除标准的研究中ANA阳性的JIA患者的比例。通过筛选稀释对ANA呈阳性的JIA患者和葡萄膜炎患者的比例进行了森林图和汇总估计。还评估了研究异质性。
结果：28项研究符合纳入标准，产生6250名独特患者；5902名患有JIA，348名是健康对照或已知患有其他自身免疫性疾病。报告最多的IFA血清筛查稀释度≥1：80，占41.9％的患者，该筛查稀释度的JIAANA阳性比例最高（41.0％；95％CI25.0％-57.0％）。ANA筛查JIA葡萄膜炎的敏感性和特异性在≥1:40时为75％（95％CI46％-100％）和66％（95％CI39％-93％），分别。JIA亚型和ANA滴度均存在显著的研究异质性。
结论：尽管用于调查JIA的ANAIFA筛选稀释度存在很大差异，最常见的稀释是1:80.目前的文献有几个重要的缺陷，在这篇综述中发现，需要额外的研究来告知ANA筛查稀释物在JIA和JIA相关葡萄膜炎中的临床价值。
