Department of Life Sciences, University of Bath.
Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, UK.
Curr Opin Rheumatol. 2024 Nov 1;36(6):481-487. doi: 10.1097/BOR.0000000000001039. Epub 2024 Aug 19.
This review aims to provide an update on myositis autoantibody testing strategies. We have focussed on the reliability and usefulness of different myositis autoantibody detection methods, including commonly used solid phase immunoassays and newer discovery techniques.
Several studies have highlighted the limitations of currently available immunoassays, particularly when used in populations with low pretest probability and without supporting clinical evidence. While many autoantibodies, such as anti-Jo1, are detected with high sensitivity and specificity, the low incidence of myositis autoantibodies in tested populations reduces their positive predictive value. The low sensitivity of line immunoassays to detect key myositis autoantibodies, including anti-TIF1γ and rarer antisynthetase autoantibodies, is a concern.
Myositis autoantibodies are widely accepted as important clinical tools, and hence, there is a significant demand for reliable, accessible, and affordable detection methods. False positives and negative results have the potential to impact on patient care, particularly for malignancy and lung disease associated autoantibodies. Increased availability of myositis autoantibody testing has led to a rise in requests from a broader range of clinicians. It is critically important that clinicians are aware of specific limitations of tests and interpret results in the context of clinical findings.
本文旨在更新肌炎自身抗体检测策略。我们重点关注不同肌炎自身抗体检测方法的可靠性和实用性，包括常用的固相免疫测定法和较新的发现技术。
几项研究强调了现有免疫测定法的局限性，特别是在低预检测概率人群中且无支持的临床证据时。虽然许多自身抗体（如抗-Jo1）具有较高的敏感性和特异性，但在检测人群中肌炎自身抗体的发病率较低降低了其阳性预测值。线免疫分析法检测关键肌炎自身抗体（包括抗-TIF1γ 和较罕见的抗合成酶自身抗体）的敏感性较低令人担忧。
肌炎自身抗体被广泛认为是重要的临床工具，因此，对可靠、可及且经济实惠的检测方法存在巨大需求。假阳性和假阴性结果有可能影响患者的治疗，尤其是与恶性肿瘤和肺部疾病相关的自身抗体。肌炎自身抗体检测的可用性增加导致更广泛的临床医生提出了更多的检测需求。临床医生了解检测的具体局限性并根据临床发现解读结果至关重要。
