Related Experiment Videos
Antinuclear antibodies in children with chronic nonspecific complaints
Insights
A study found over half of children with chronic nonspecific symptoms tested positive for anti-nuclear antibodies (ANA). This suggests autoimmune factors may contribute to conditions like childhood fatigue, warranting further investigation before diagnosing psychogenic disorders.
Area of Science:
- Pediatric immunology
- Autoimmune diseases
- Clinical diagnostics
Background:
- Chronic nonspecific symptoms are common in pediatric clinics.
- Some children with these symptoms have positive anti-nuclear antibodies (ANA) without meeting criteria for collagen diseases.
- School refusal is a frequent diagnosis for children with unexplained chronic complaints.
Purpose of the Study:
- To investigate the prevalence of ANA in children with chronic nonspecific symptoms.
- To explore potential associations between ANA positivity and specific symptoms or outcomes.
- To propose a new disease entity for autoimmune-related fatigue in children.
Main Methods:
- Prospective study of children presenting with chronic nonspecific symptoms.
- Anti-nuclear antibody (ANA) testing via indirect immunofluorescence.
- Autoantibody analysis using Western immunoblot.
- Comparison with healthy control children.
Main Results:
- 52.4% of symptomatic children were ANA positive, compared to 6.1% of controls (p < 0.0001).
- ANA positive patients showed higher rates of fatigue and low-grade fever, while ANA negative patients had more gastrointestinal and orthostatic dysregulation symptoms.
- Children with high ANA titers were more likely to experience school absenteeism.
Conclusions:
- Autoimmune mechanisms may underlie chronic nonspecific symptoms in children.
- The findings support the proposal of a new disease entity: autoimmune fatigue syndrome in children.
- Immunological evaluation should be considered for chronically complaining children to avoid misdiagnosis as school refusal or psychogenic disorders.
Abstract:
Children who are chronically complaining nonspecific symptoms such as headache, fatigue, abdominal pain, and low grade fever are commonly seen in daily pediatric outpatient clinics. Some of them are unable to go to school and are diagnosed as school refusal by physicians or educational staff. On the other hand, there are children who do not fulfill any criteria of collagen diseases and whose anti-nuclear antibodies (ANA) are found to be positive. Some of these children have chronic nonspecific complaints. We prospectively studied the prevalence of ANA in children who visited a pediatric outpatient clinic because of chronic nonspecific complaints. Surprisingly, 74 out of 140 symptomatic children (52.4%) were positive for ANA, while only 5 out of 82 healthy control children (6.1%) were positive (p < 0.0001). 39 of 74 ANA positive patients (52.1%) have low ANA titers < or = 1:80, nevertheless 36 patients (47.9%) have high ANA titers > or = 1:160. ANA fluorescent patterns were homogeneous and speckled in 75.3%, speckled in 17.6% and others in 6.8%. ANA positive patients tended to have general fatigue and low grade fever, while gastrointestinal problems such as abdominal pain and diarrhea and orthostatic dysregulation symptoms were commonly seen in ANA negative patients. Children who were unable to go to school more than 1 day a week were seen significantly more in ANA positive patients than in negative patients. Autoantibody analysis using Western immunoblot revealed that 26 out of 63 ANA positive sera (41.3%) had antibodies to the 62 kD protein which had not been previously noticed. These data suggest that autoimmune mechanism may play a role in childhood chronic nonspecific symptoms. We therefore propose a new disease entity of the autoimmune fatigue syndrome in children. When chronically complaining children visit a pediatric out-patient clinic, immunological approaches should be considered before they are discriminated as school refusal or having psychogenic disorders.