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Título

SERUM PRESENCE OF ANTINUCLEAR ANTIBODIES IN NMOSD PATIENTS RELATES TO AQP4-IGG REACTIVITY

Resumo

Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune and demyelinating disease of the central nervous system (CNS), whose pathophysiology is related to the anti-aquaporin 4 autoantibody (AQP4-IgG). Patients with NMOSD tend to present with concurrent autoimmune diseases, such as systemic lupus erythematosus (SLE), Sjögren's syndrome (SS) and Hashimoto's thyroiditis (HT). These patients may also express autoimmunity biomarkers, such as antinuclear antibodies (ANA), even without a given diagnosis of other autoimmune diseases. Therefore, we aimed to evaluate the influence of the serum presence of ANA on clinical and prognostic aspects of NMOSD patients. Methods: Cross-sectional study carried out in a public outpatient clinic (Ambulatório Magalhães Neto, HUPES-UFBA) in Salvador, Brazil. Clinical and demographic data were collected using a standardized questionnaire. Laboratory and MRI results were obtained through a retrospective search of medical records. EDSS, annualized relapse rate (ARR) and progression index (EDSS/disease time) were used as prognostic parameters. Results: 106 patients were enrolled, of which 85 (80.2%) were female and 84 (79.2%) were afrodescendants. The mean age at disease onset was 36.5 (±13.6) years. Sixteen (15.6%) patients were diagnosed with a concomitant autoimmune disease, the most frequent being HT (6.8%) and SLE (3.8%). 41 patients had documented ANA results. ANA was positive in 23 (52.3%) patients. Serum presence of ANA was related to reactivity for AQP4-Ig with a trend towards statistical significance (85.7% vs 57.1%; p=0.089). ANA positive patients had a higher frequency of concomitant autoimmune diseases, although without statistical significance (28,6 vs 14,3; p=0.406). There were no significant differences between the groups regarding age at onset (39,4 ± 8,4 vs 38,5 ± 17,0; p=0.871), sex (85,7% vs 82,1%; p=1.000), initial clinical core syndrome (p=1.000 for transverse myelitis; p=1.000 for optic neuritis), EDSS (4,5±2,4 vs 5,2±2,8; p=0.424), ARR (1,6±1,6 vs 2,0±1,8; p=0.749) or progression index (4,9±5,6 vs 3,7±5,5; p=0.938). Conclusion: The serum presence of ANA was not related to specific clinical syndromes at disease onset nor to a worse prognosis in patients with NMOSD. An interrelationship between ANA and AQP4-IgG was observed, ratifying the humoral autoimmunity predisposition in NMOSD patients. HT and SLE were the most prevalent diseases concurrent with NMOSD in our sample.

Palavras Chave

Neuromyelitis Optica Spectrum Disorder, Autoimmunity, Antinuclear antibodies, Anti-aquaporin 4 antibody, Prognosis