Performance of myositis-specific antibodies detected on myositis line immunoassay to diagnose and sub-classify patients with suspected idiopathic inflammatory myopathy, a retrospective records-based review.

Abstract

AIM:

To evaluate myositis line immunoassay (LIA) for diagnosis and sub-classification of suspected idiopathic inflammatory myopathy (IIM). To investigate if test performance is improved by increasing signal strength cut-off for myositis-specific antibody (MSA) or combining MSA with indirect immunofluorescence (IIF).

METHODS:

A retrospective, consecutive case series of patients investigated for MSAs from June 2013 to June 2020 for suspected IIM. Specificity, sensitivity, positive predictive value, and negative predictive value were calculated with 95% confidence intervals for diagnosis of IIM. Association of IIM diagnosis with increased signal strength and presence of an expected IIF pattern on Hep-2 cells was assessed by Fisher's exact test in MSA-positive patients.

RESULTS:

A total of 195 patients were evaluated. IIM was diagnosed in 32/195 (16.4%) patients. MSAs were detected in 41/195 (21%) patients, 18/41 (43.9%) patients with an MSA had a diagnosis of IIM. The probability of an IIM diagnosis was increased in MSA-positive patients with high compared with low signal strength (83.3% vs 43.5%; P = 0.01) and an expected compared with unexpected IIF pattern (61.5% vs 23.8%; P = 0.04). Specificity for IIM was not significantly improved by increasing signal strength cut-off (85.9% vs 93.8%). Positive predictive value of myositis LIA was only modest and not significantly improved by either increasing signal strength cut-off or requiring an expected IIF pattern for determination of MSA positivity (43.9% vs 60% vs 61.5%). Sub-classification of IIM correlated closely for respective MSAs (88.9%).

CONCLUSION:

Increased MSA signal strength on myositis LIA and the presence of an expected IIF pattern were associated with IIM diagnosis. Test performance was non-significantly improved by these methods. Prevalence of IIM in this patient cohort was low; it is not excluded that LIA performance could be improved by these methods in a higher prevalence cohort.

• Authors: Thomas J Beaton, David Gillis, Kerri Prain, Karen Morwood, James Anderson, John Goddard, Timothy Baird
• Journal: International journal of rheumatic diseases (Int J Rheum Dis) Vol. 24 Issue 9 Pg. 1167-1175 (Sep 2021) ISSN: 1756-185X [Electronic] England
• PMID: 34250724 (Publication Type: Evaluation Study, Journal Article)
• Copyright: © 2021 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

Chemical References

• Autoantibodies
• Autoantigens
• Biomarkers

Topics

• Adult
• Aged
• Aged, 80 and over
• Autoantibodies (blood)
• Autoantigens (immunology)
• Biomarkers (blood)
• Cell Line
• Female
• Fluorescent Antibody Technique
• Humans
• Immunoassay
• Male
• Middle Aged
• Myositis (blood, classification, diagnosis, immunology)
• Predictive Value of Tests
• Reproducibility of Results
• Retrospective Studies