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Do we need broad immunological work-up in all patients with CIS?
Ivan Adamec1, Mateja Bošković, Ana Škvorc
1University Hospital Center Zagreb, Department of Neurology, Referral Center for Demyelinating Diseases of the Central Nervous System, Zagreb, Croatia.
Journal of the Neurological Sciences
|December 6, 2011
Summary
Many patients with clinically isolated syndrome (CIS) show altered immunological tests, but these are clinically insignificant for diagnosing other autoimmune diseases. Extensive screening is not recommended for CIS patients.
Area of Science:
- Immunology
- Neurology
- Autoimmunity
Background:
- Clinically isolated syndrome (CIS) is an early stage of multiple sclerosis (MS).
- Altered immunological tests are common in CIS patients, but their clinical significance is unclear.
- Determining the prevalence and significance of immunological abnormalities in CIS is crucial for diagnosis and management.
Purpose of the Study:
- To investigate the prevalence of altered immunological tests in patients with CIS.
- To assess the clinical significance of these immunological abnormalities.
- To evaluate the utility of extensive immunological work-up in CIS patients.
Main Methods:
- Retrospective analysis of medical records from 726 CIS patients hospitalized between 2008-2010.
- Comprehensive immunological testing including ANA, ENA, ANCA, aCL IgG/IgM, C3, C4, CH50, anti-TPO, AST, and RF antibodies.
- Correlation analysis of positive antibody results and clinical manifestations.
Main Results:
- Of 418 patients with complete testing, 56.2% had altered immunological tests.
- Prevalence of specific altered tests: antinuclear antibodies (17.4%), ENA (3.3%), aCl IgG (11.2%), aCl IgM (19.8%), anti-TPO (3.1%).
- No correlation found between ANA, aCl IgG, or aCl IgM positivity; no patients exhibited clinical signs of other autoimmune diseases.
Conclusions:
- Altered immunological tests are frequent in CIS patients but lack clinical expression of other autoimmune conditions.
- Extensive immunological screening is not warranted for all CIS patients.
- Focused immunological testing, rather than a broad screening panel, is recommended for CIS evaluation.