Do patients with rheumatoid arthritis (RA) who also have a positive test for anti-nuclear antibody (ANA) have a different disease course or treatment needs than those who test negative for ANA? A retrospective, population-based, cohort study by Pakinar et al. published in ACR Open Rheumatology in June examined patients with RA who are either ANA positive or ANA negative, highlighting apparent differences in their disease progression, disease course, therapies and characteristics.1
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In their introduction, Pakinar et al. discussed past studies that have questioned the role of routine ANA testing in patients with RA, with mixed findings on connections between ANA positivity, treatment and specific RA outcomes. For example, a 2005 observational study found patients with ANA-positive RA who were treated with tumor necrosis factor (TNF) inhibitors were more likely to have certain autoimmune complications, including a drug-induced lupus, than those not treated with TNF inhibitors.2 However, a single cohort study published in 2014 of 454 patients with RA treated with a TNF inhibitor did not show any clear association between ANA positivity and the lupus-like complication. In that 2014 study, some links were made between the development of ANA positivity during treatment and secondary treatment nonresponse.3
The current study was launched to learn more about possible differences between ANA positivity in patients with RA and their disease course and treatment.
The researchers at the Mayo Clinic, Rochester, Minn., examined data collected from residents in surrounding Olmsted County who first fulfilled the 1987 ACR criteria for RA from 2009 to 2014. The data included rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (anti-CCP) and ANA results collected when the patients first showed signs of joint swelling. The data also contained patients age, sex, smoking status and presence of obesity at the time of RA criteria fulfillment. The researchers accessed medical records from patients treated at multiple healthcare facilities in the county through the Rochester Epidemiology Project. Their results were first presented at ACR Convergence 2020.
“Even in the general population, there have been some observable differences between ANA-positive and ANA-negative individuals. Could there be differences between these groups in RA patients?” asks Sujaytha S. Paknikar, MD, an internal medicine resident at the Mayo Clinic and a study co-author.
When female patients with suspected systemic lupus erythematosus (SLE) or scleroderma first present to a rheumatologist, ANA screening often is conducted as part of the standard evaluation because early diagnosis and treatment may help prevent serious health outcomes, says Dr. Paknikar.