Advance technology in autoimmunity tests · Radiographic presence of pulmonary infiltrates or nodules) •How much information does a test result give? How much more probable is vasculitis?

The world leader in serving science

Advance technology in autoimmunity tests Dr Chia-Ching Lin

Global marketing autoimmunity Immunodiagnostics division April 24th 2018

2

Sweden

bull Uppsala ndash Allergy

bull Global headquarters

bull PHC (Pharmaceutical and Healthcare Collaborations)

bull Helsingborg ndash Allergy

bull Allergon ndash Allergen raw material

Germany

bull Freiburg ndash Autoimmunity

Immunodiagnostics division - centers of excellence

3

The product range in autoimmunity

Connective tissue diseases

Rheumatoid arthritis

Anti-phospholipid syndrome

ANCA-associated vasculitis

Celiac disease

Inflammatory bowel diseases

Thyroid diseases

Autoimmune liver diseases

4

50 markers for gt 20 different

autoimmune diseases

5

Phadia Laboratory Systems

6

Pathogenesis of autoimmune diseases

bull Mostly T cells are the trigger

bull Autoantibodies are usually not triggers but useful markers

bull Genetic predisposition (specific HLA class II alleles)

bull More frequent in women ndash female hormones increase the risk disease often starts in times of hormonal changes

bull Possible triggers for AI diseases

bull Viral or bacterial infections (cross reactivity with common epitopes)

bull Wrong expression of MHC class II antigens of normal tissue cells

bull Vaccination

bull Antibiotics

bull hellip


Modern technology used nowadays to help autoimmune disease diagnosis - ANCA-associated vasculitis

8

Rheumatoid Arthritis

EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome

EliA b2 Glycoprotein-I IgG

EliA b2 Glycoprotein-I IgM

EliA b2 Glycoprotein-I IgA

EliA Cardiolipin IgG

EliA Cardiolipin IgM

EliA Cardiolipin IgA

Connective Tissue Diseases

EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA

EliA Intrinsic Factor

EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

EliA test panel for autoimmune diseases

9

Anti-Neutrophil Cytoplasmic Antibodies on indirect immunofluorescence assay (IIF)

bull cytoplasmic ANCA = c-ANCA

bull Antigen in most cases anti-proteinase 3

(PR3)

bull perinuclear ANCA = p-ANCA

bull Antigen in most cases anti-myeloperoxidase

(MPO)

bull sometimes other enzymes from

granulocytes but in these cases usually not

related to vasculitis

bull atypical ANCA

bull Not identifiable as p- or c-ANCA

bull Different antigens usually not specific for


c-ANCA

staining the

whole

cytoplasm of

the

granulocytes

p-ANCA

staining only

the

surrounding

of the cell

nucleus

10

Recommendations from

1990

IIF ANCA as first-line test

all positives measured

on antigen-specific tests

Multicenter study 2016

IIF ANCA have a much

lower likelihood ratio than

antigen-specific tests

IIF as first-line test

Source see next page

Damoiseaux et al 2016 Ann Rheum Dis 201601

11

Damoiseaux J et al 2016

ldquoConsequently dual IIFantigen-specific immunoassay

testing of each sample is not necessary for maximal

diagnostic accuracy These results indicate that the

current international consensus on ANCA testing for AAV

needs revisionrdquo

12

New Consensus

Bossuyt et al 2017Nat Rev Rheumatol 13683

13

New Consensus


14

Will ANCA IIF be obsolete

bull For autoimmune vasculitis ANCA IIF is no longer deemed suitable as the

first screening test1

bull However for hepatitis and inflammatory bowel syndrome ANCA IIF still

might be of interest1

bull For these diseases antigen-specific tests such as EliA PR3S and EliA

MPOS are not of diagnostic use as in most cases other antigens are

responsible for the ANCA pattern1

1Bossuyt et al 2017Nat Rev Rheumatol 13683ndash692

15

bull What is the meaning behind the numbers

bull Example 10 IUml EliA MPOS (Cutoff = 5 IUml)

bull How high is the risk for the patient to have an autoimmune vasculitis

(Post-test probability)

How to interprete the test result

16

bull Likelihood Ratio in intervals of

antibody titer

bull A patient with relatively low

probability for vasculitis (eg

Radiographic presence of

pulmonary infiltrates or nodules)

bull How much information does a test

result give How much more

probable is vasculitis


Bossuyt et al 2017 Rheumatology (Oxford) 56(9) 1533

EliA MPOs and EliA

PR3s

Positive

Likelihood

Ratio

Percentage of

vasculitis

patients in a

multicenter study

(n=1175)

0 - 21 IUml 01 10

21 ndash 49 IUml 335 8

50 ndash 160 IUml 12 18

160 ndash 1420 IUml 59 57

1420 ndash 1800 IUml infin 7

17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility

Pre-test probability

EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180

How to interpret test results Example 10 pre-test probability

10 pre-test probability

bull radiographic evidence of mucosal thickening

involving one or more sinuses

bull radiographic presence of pulmonary infiltrates or

nodules or both

IUml

30

1

60

90

100

Bossuyt et al 2017 Rheumatology (Oxford) 56(9) 1533-41

18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180



bull radiographic evidence of mucosal thickening involving one or more sinuses

bull radiographic presence of pulmonary infiltrates or nodules or both

bull urinalysis demonstrating hematuria and red blood cell casts

IUml



Modern technology used nowadays to help autoimmune disease diagnosis - Rheumatoid arthritis

20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21

Current ACR classification criteria

A score of at least 610 is needed for classification of a patient as having definite RA

Score

1 Joint involvement

1 large joint 0

2 ndash 10 large joints 1

1 ndash 3 small joints (with or without involvement of large joints) 2


gt10 joints (at least 1 small joint) 5

2 Serology (at least 1 test result is needed for classification)

Negative RF and negative ACPA 0

Low-positive RF or low-positive ACPA 2

High-positive RF or high-positive ACPA 3

3 Acute-phase reactants (at least 1 test result is needed for classification)

Normal CRP and normal ESR 0

Abnormal CRP or abnormal ESR 1

4 Duration of symptoms

lt6 weeks 0

6 weeks 1

ldquoantindashcitrullinated

protein antibody

(ACPA) (tested as

antindashcyclic

citrullinated peptide

[anti-CCP])rdquo

Kay and Upchurch 2012 Rheumatology (Oxford)51 Suppl 65-9

22

CCP antibodies appear in early stage of disease

bull Anti-CCP may appear years before first symptoms occur

0

10

20

30

40

50

60

70

80

0246810

years before first symptoms

CC

P-2

po

sit

ive

Rantapaumla-Dahlqvist et al 2003 Arthritis Rheum 48 2741-2749

23

The target gain time

without treatment

treatment with biologicals

conventional treatment


time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability

conventional treatment Diagnosis

Diagnosis

24

Antibody prevalence in associated disease(s) Rheumatoid Arthritis Associated Disease(s) Antibody

Prevalence []

EliA CCP Well Rheumatoid Arthritis 70-80

Juvenile Idiopathic Arthritis (but associated with

polyarticular manifestation)

0-15

Psoriatic Arthritis 7-16

EliA RF IgM Well

Rheumatoid Arthritis 70-80

Sjoumlgrenrsquos Syndrome 55-70

Systemic Lupus Erythematosus 15-35

Scleroderma 20-30

Mixed Connective Tissue Disease 50-60

Granulomatosis With Polyangiitis 5-20

Endocarditis Lenta 25-60

Chronic hepatitis Primary Biliary Cirrhosis 15-70

Tuberculosis 15

Bacterial Infections 5-60

Parasite infections 20-90

Viral Infections 15-65

K Conrad WS F Hiepe M J Fritzler Autoantibodies in Systemic Autoimmune Diseases A Diagnostic Reference 3ed Pabst Science

Publishers 2015

25

Why is testing of RF still indicated

bull Combination of anti-CCP and RF IgM for a reliable diagnosis of RA

according to the diagnostic criteria1

bull Individual RF isotype measurement for a better prognosis of RA to help

the clinician in the treatment decision2

bull

bull RF isotypes with high titer have a good specificity for RA to differentiate

from other diseases13

1 Kay and Upchurch 2012 Rheumatology (Oxford)51 Suppl 65-9

2 Ingegnoli et al 2013 Dis Markers 35(6)727

3 Shiboski et al 2012 Arthritis Care Res (Hoboken) 64(4)475

26

More reliable diagnosis of RA through the combination of EliA CCP and EliA RF IgM IgA and IgG

Triple positivity of RF isotypes makes RA almost certain even in

CCP-negative patients

bdquoMeasurement of all 3 isotypes of RF may increase by 7- to 21-fold

the chance of making the serologic diagnosis of RAldquo2010)

Test results Interpretation

RF IgM RF IgA RF IgG CCP2 Probability for RA

+ + + - Almost certain

+ + + + Almost certain

+ + - + Almost certain

- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible

Jaskowski et al 2010 J Rheumatol 137(8)1582

27

bull JIA comprises a heterogeneous group of rheumatic joint disease with an

onset in childhood (before 16th of age)

bull Autoantibodies are not considered to be of diagnostic help but have

relevance in differential diagnosis1

bull International League of Associations for Rheumatology classification of

juvenile idiopathic arthritis second revision Edmonton 20012

bull Systemic Arthritis

bull Oligoarthritis

bull Polyarthritis (RF-)

bull Polyarthritis (RF+)

bull Psoriatic arthritis

bull Enthestitis related arthritis

bull Undifferentiated arthritis

Juvenile idiopathic arthritis (JIA)

1 Schoenfeld and Meroni 2012 The general practice Guide to Autoimmune diseasesPabst Science Publishers

2 Petty et al 2004 J Rheumatol 31(2)390

28

bull Anti-CCP antibodies are associated with RF positive polyarticular course of

JIA

Brunner and Sitzmann Clin Exp Rheumatol 2006 24(4)449

Conrad et al Autoantibodies in Systemic Autoimmune Diseases A Diagnostic Reference 3rd Ed 2015

Tebo et al Pediatric Rheumatology 2012 1029

CCP in JIA

29

Thank you


Say goodbye to the last-generation technology ndash How tests nowadays help autoimmune disease diagnosis

31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune

connective tissue diseases

Prevalence Incidence

Sjoumlgrenlsquo s syndrome (SS) 05 -1 100 60 100000

systemic lupus erythematosus

(SLE)

3 - 400 100000 51 100000

Scleroderma 4 ndash 253 1000000 210 1000000

Dermatomyositis Polymyositis

(DMPM)

15 1000000 60 1000000

Mixed connective tissue disease

(MCTD)

50 100000 20 1000000

Prevalence and Incidence of connective tissue diseases (CTDs)

Schoenfeld et al 2006 Autoantibodies 2nd EdElsevier

Schoenfeld et al Diagnostic Criteria in Autoimmune Diseases 1st Ed Humana Press

Hochberg et al 2014 Rheumatology 6th Ed Elsevier

33

bull No single characteristic feature

bull Common symptom - nonspecific fatigue

bull A wide variety of symptoms may occur

bull fever

bull muscle and joint pain and stiffness

bull weakness

bull many other symptoms

bull specific andor non-specific autoantibodies could present

bull Multi-organs are affected especially skin joints lungs

bull Diagnosis mixture of the examination

laboratory results and image diagnostic aid the final diagnosis of connective tissue

diseases which will be made by the physicians

Difficulty of autoimmune connective tissue disorders diagnosis

Gordon and gross 2011 Connective tissue diseases Clinical Publishing

34

Fatigue

Hair fall

Oral Ulcer

Arthralgia

Raynaudlsquos phenomenon

Fevers

And many many more

SLE SLE- first symptoms

Hochberg MC1997 Arthritis Rheum 40 1725

35

SLE


36

bull Antibody against RoLa can cross the placenta and create a syndrome

called Neonatal lupus1

bull Could occur up to

bull 1-2 of infants from mothers with SLE12

bull 15-20 of infants from mothers with SLE and anti-Ro Ab12

bull Auto-antibodies directed against Ro52 kDa are associated with a higher

risk of congenital heart block (CHB)3

bull CHB is believed to affect approximately 2 of offspring exposed to anti-

Ro Ab4

Neonatal lupus

1 Hochberg et al 2014 Rheumatology 6th Ed Elsevier

2 Buyon and Clancy 2005 Dis Clin North Am 31(2)299

3 Sawalha and Harley 2004 Curr Opin Rheumatol 16(5)534

4 Brucato et al 2002 Lupus 11(11)716

37

SLE


38

How are ANA detected

bull The most popular screening test for ANA is the indirect

immunofluorescence assay (IIF) using HEp-2 cells as substrate

bull IIF detects all ANA with high sensitivity

(except for Ro521 Ro601 Jo-123 and Rib-P4 antibodies)

bull What you get as result is a certain pattern

1 Mahler et al 2014 J Immunol Res 315179

2 Hoffman et al 2002 Arthritis Res 4(Suppl 1) 84

3Loacutepez-Hoyos et al 2007 Ann N Y Acad Sci1109322

4 Mahleret al 2008 Arthritis Res Ther 10(6)R131

39

How can you differentiate ANA in IIF

A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled

E dense fine speckled

F centromeric Mariz et al 2011 Arthritis Rheum 63(1)191

40

Which Antibodies are responsible for these patterns

Chan et al 2015 Front Immunol 206412

41

The relevance of ANA-IIF

bull Antinuclear antibodies occur

bull in various autoimmune diseases

bull Connective tissue diseases (CTD)

bull Autoimmune hepatitis

bull Primary biliary cirrhosis

bull Rheumatoid arthritis

bull Addisonrsquos disease

bull Hashimoto thyroiditis

bull Type 1 diabetes mellitus

bull as well as in non-autoimmune diseases1

bull Cancer

bull Gastrointestinal diseases

bull Lung diseases

bull Skin diseases

bull Infections

bull ANA are positive in a considerable proportion of the healthy population2

ANA-IIF are not very specific for certain diseases

BUT ANA are mainly used to support diagnosis of CTDs

1 Malleson et al 2010 Pediatric Rheumatology 827

2 Satoh et al 2012 Arthritis Rheum64(7) 2319

42

What is the effect

Satoh et al 2012 Arthritis Rheum64(7) 2319

A sign of low test specificity

bull The overall prevalence of ANA in the

US population was 138 323 million

people while the prevalence of CTD is

lt05 or 15 million

bull There is a high degree of false positive

in the general population

43

Which test provides higher diagnosis accuracy

Lab performs 1000 screen incidence for CTD is 10 so 900 patients have no CTD

and 100 of them have CTD

ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95

Test sensitivity 100 = 100 CTD patients identified

Test specificity 100 = 900 healthy individual excluded

Jeong et al 2017 PLoSONE 2(3

44




EliA CTD Sen 74 Spe 95

test POS test NEG

CTD 74 26

none-CTD 45 855

119 881

ANA-IIF Sen 89 Spe 77

test POS test NEG

CTD 89 11

none-CTD 207 693

296 704

PPV 30 NPV 98 PPV 62 NPV 97


45

Does IIF detect all antibodies

bull HEp-2 and even HEp-2000 ( only spiked with Ro60 antigen) has a

problem to detect Ro52 and even Ro60 antibodies1

bull Jo-1 is difficult to detect by IIF23

bull Rib-P is difficult to detect by IIF4





46

bull Pediatric rheumatologists have pointed out in the literatures that the ANA is a poor screening test and is being used inappropriately1234

bull the ANA test has such a high false-positivity rate that a positive test is of little if any clinical utility as a screening test and should not be ordered routinely to screen children with musculoskeletal complaints5

bull Its use should be limited to the diagnosis of SLE MCTD and similar systemic illnesses5

How about ANA-IIF in pediatric rheumatology

bull ANA-IIF has a problem in detecting some autoantibodies

bull ANA-IIF is not very specific

EliA CTD screen has higher clinical utility

1Deane et al 1995 Pediatrics 95892-5

2 McGhee et al 2002 Pediatrics 110354-9

3 Siegel 2003 Pediatr Rev 24320-1

4 Jarvis 2008 Pediatr Rheumatol Online J 619-23

5 Malleson et al Pediatric Rheumatology 2010 827

47

EliA CTD Screen can help detect specific CTDs1

EliA CTD Screen has a high sensitivity for Sjӧgrenrsquos syndrome and

systemic sclerosis

dsDNA Ro La Sm CENP-B U1RNP SCL-70 Jo-1

Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0

Confirmed antibodies (n=223) and their detection

Robier C et al 2016 Clin Chem Lab Med 54(8)1365

Test result positive single test should be ordered according to clinical

symptoms

48

EliA CTD Screen identifies the most common connective tissue diseases

Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus

Scleroderma Polymyositisdermatomyosi

tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15

CENP 70-90 limited9 Jo-1 25910 U1RNP 10078

Ro60 kDa 70-

10012

Ro52 kDa 40-5034 Scl-70 70 systemic7 Ro52 kDa 2386 RNP70 10078

La 35-7012 Ro60 kDa 40-5034 RNA Pol III 4-25

systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66

La 6-155 Fibrillarin 6-820

PCNA lt518 Pm-Scl 32122

Polymyositisscleroderma (overlap syndrome)

Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common

1 Wenzel J et al British Journal of Dermatology 2001 2 Yoshimi R et al Clinical and Developmental Immunology 2012 3 van den Hoogen FHJ and van de Putte LBA Manual of Biological Markers of Disease 1996 pp C31 1-8 4 Reichlin M and Scofield RH Autoantibodies 1996 pp 783-788 5 Keech CL et al Autoantibodies 1996 pp 789-797 6 Dugar M et al Postgrad Med J 2010 7 Tan EM Immunologist 1999 8 Peng SL and Craft JE Autoantibodies 1996 pp 774-782 9 Craft J and Hardin J Dubois Lupus Erythematosus 1992 pp 216-224 10 Maddison PJ Autoantibodies 1996 pp 31-35 11 Kuwana M et al ArthritisRheum 1994 12 Reveille JD et al Semin Arthritis Rheum2001 13 Ihn H et al Clin Exp Immunol1996 14 Sharp GC et al N Eng J Med1976 15 Hochberg MC Arthritis Rheum 1997 16 Gerli L and Caponi L Autoimmunity 2005 17 Linnik MD et al Arthritis Rheum 2005 18 Mahler M et al Autoimmun Rev 2012 19 Nikpour M et al Arthritis Research amp Therapy 2011 20 Conrad K et al Autoantibodies in systemic autoimmune diseases - A diagnostic reference 21 Ho KT and Reveille JD Arthritis Res Ther 2003 22 Walker JG and Fritzler MJ Curr Opin Rheumatol 2007 23 Ghirardello A et al Clin Rev Allergy Immunol 2010

lt L

ess c

om

mo

n

Less common gt

49

Summary

bull CTDs are rare and diagnosis is complicated12

bull At low titres the chance of false positives with ANA-IIF increases3

bull Incorrect diagnosis can cause patients emotional and physical harm45

bull EliA CTD Screen offers equivalent sensitivity and superior specificity to

ANA-IIF and can help detect specific CTDs67

bull EliA CTD Screen has been successful as a first-line test in the real

world8

1 Hochberg MC et al 2014 Rheumatology sixth edition

2 Rasmussen A et al 2016 Rheumatology 55(7)1195-20

3 Op De Beeck K et al 2011 Autoimmun Rev10(12)801

4 Celińska-Loumlwenhoff M and Musiał 2012 J Psychiatria Polska 46(6)1029

5 Narain S et al 2004 Arch Intern Med164(22)2435

6 Otten HG et al 2017 Clin Exp Rheumatol 35(3)462

7 Robier C et al 2016 Clin Chem Lab Med 54(8)1365

8 Wood G et al 2016 Pathology in Practice 1747

50

Thank you

51

Spectrum of Autoimmune Diseases

Organ Specific Autoimmune Diseases Diabetes mellitus Typ I (juvenile diabetes)

Hashimoto Thyroiditis

Basedow

Celiac Disease

Goodpasture-Syndrome

Ulcerative Colitis Crohnacutes Disease

Primary Biliary Cirrhosis

Myasthenia Gravis

Sjoumlgrenacutes Syndrome

Dermato-Polymyositis

Vasculitis


MCTD

Scleroderma

Systemic Lupus Erythematosus SLE

Systemic Autoimme Diseases

52

Conclusion

bull In more than 95 of all ANA requests the physician wants to know if

CTD plays a role in these patients

bull 4 of 5 ANA positive results cannot be traced back to antigens with

known clinical relevance

bull IIF results have only a limited clinical usefulness for the doctors

bull Other test methods can be used according the ACR

52

Is IIF still the first test to use

53

54

Is there a clinical usefulness of IIF results

bull Even high titres (1640) have only a positive predictive value of 35

for connective tissue diseases (CTDs)

bull ANA in IFA have a predictive value of 11 for SLE and 11 for other

CTDs



54

IIF results have only a limited clinical usefulness for

the doctors

55

EliA CTD Screen offers equivalent sensitivity and superior specificity to ANA-IIF12

EliA CTD Screen has a high sensitivity for Sjӧgrenrsquos syndrome

systemic sclerosis and mixed connective tissue disease2

n ANA-IIF 1100 EliA CTD Screen

Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100


1 Otten HG et al Clin Exp Rheumatol 2017 2 Robier C et al Clin Chem Lab Med 2016

Further support from Jeong S et al PLoS ONE 2017 Op de Beeck K et al 2011 and van der Pol P et al Poster presented at Erasmus MC 2017

56

Clinical features of SLE

Definition Inflammatory rheumatic systemic disease with a

potential involvement of all organs

Sex Ratio male female = 1 9

Age Every age peaks at 15-25 and 40-50 years

Critical manifestations kidneys CNS

Most frequent cause of death Infections

Diagnosis 4 of 11 ACR-criteria have to be fulfilled

57

Criteria of SLE


58

SLE early skin lesions and butterfly rash

59

SLE Skin manifestations

60

SLE manifestations neuropsychiatric

bullanything possible

bullmild concentration disorder personality

change

bullepilepsy depression psychosis

bullbehaviour disturbances

bullstroke movement disorders

61

Scleroderma

Definition Fibrosing systemic disease with lesions of the

vessels leading to atrophy and fibrosis of almost all

organs (Fibrosis = proliferation of connective tissue)

Sex Ratio malefemale = 12

Age mostly adults peak at 40-50 years

Diagnosis ARA-criteria 1 main criterium (= symmetric

sclerodermal lesions of joints) and at least 2 of 3

minor criteria

62

Clinical features of systemic sclerosis

bull Raynaudlsquos phenomenon

bull Honeycomb lung

bull Diffuse skin systemic sclerosis with

pigmentation

bull Systemic sclerosis

telangiectasia (rat bites) small mouth

63


bull Digital tip ulcers

bull Picture reference httpswwwstudybluecomnotesnotensclerodermadeck4903313

bull Fingertip pitting scares

bull Picture reference httpwwwhuidziektennlzakboekdermatosenstxtSclerodermiaGeneralisatahtm

bull Puffy fingers

bull Picture reference httpspicturesdoccheckcomcomphoto18450-scleroderma-hands-1

bull Systemic sclerosis trying to make fists

64

First symptoms

Fatique


Swollen face and hands in the morning

Further course

Calcium deposits in the skin

Ulcerations of the fingers

Telangiectasis (small dilated blood vessels near the

surface)

Involvement of the lung in gt60

Scleroderma

65

Scleroderma

66


Definitionacute or chronic inflammatory disease of

muscle and skin


Age every age

Diagnosis 5 Criteria (5 manifestation of the skin

dermatomyositis) according to Bohan and Peter

The more criteria are fulfilled the clearer the diagnosis

67


First symptoms

Fatique

Muscle weakness in shoulders pelvis or thighs

Further course

Symmetric pain

When skin is involved redness and swelling

Pain in joints

Difficulties with speech and swallowing

Prognosis

Depending on severity but often curable with steroids and

immunosuppression

68


Criteria Dermatomyositis

bull Myopathic muscle weakness (Yes)

bull Serum skeletal muscle enzymes (High or

Normal)

bull Electromyographic findings (Myopathic)

bull Muscle enzymes High (up to 50 fold normal)

bull Muscle-biopsy findings (Perifascilular

perimysial or perivascular infiltrates

perifascilular artophy)

bull Rash of Calcinosis (present)

Criteria Polymyositis




bull Muscle-biopsy findings (primary inflammation with

CD8MCH-1 complexes and no vacuoles)

bull Rash of Calcinosis (absent)

No auto-antibody results required

Lancet 2003 Sep 20362(9388)971-82

69

Sjoumlgrenlsquos syndrome

Definition a chronic inflammatory disease of unknown cause

characterized by diminished lacrimal and salivary gland

secretion resulting in keratoconjunctivitis sicca and

xerostomia


Age 30-40 Years

Diagnosis ACR-EULAR Classification Criteria for primary

Sjoumlgrenrsquos syndrome (pSS)

70


First symptoms

Fatique

Dry eyes

Due to Lessno lacrimal fluid saliva fluid the consequences

are

Frequent eye infection even up to blindness

Diffeculty with speech to swallow (Aphasia and dysphagia)

Intense caries

Involvement of other organs esp polyarthritis is possible

Secondary Sjoumlgrenlsquos syndrome

Complication of rheumatoid arthritis (10-15) less frequent

of SLE (1-3)

71

Sjogrenacutes Syndrome - criteria

72

The classification of SS applies to any individual who meets the inclusion

criteria does not have any condition listed as exclusion criteria and who

has a score ge 4 when summing the weights from the following items


Arthritis Rheumatol 2017 Jan 69(1) 35ndash45

73

Mixed connective tissue disease MCTD

Definition Overlap syndrome with unclear characterisation a

syndrome with features of scleroderma rheumatoid arthritis

SLE and polymyositis-dermatomyositis and characteristic

high titre of U1RNP antibodies


Age every age

Diagnosis 1 of 2 general symptoms antibodies to U1RNP 2

of 3 mixed symptoms (according to Kasukawa)

74

MCTD

First symptoms

Fatique

Raynaudlsquos phenomenon (often many years in advance)

Muscle weakness

Swollen hands and general swelling of the skin

Further course

At least 50 of patients develop a classical connective tissue

disease in the course of 10 years

75

MCTD - criteria

76

Summary

1 SLE systemic All organs can be involved

Most frequent joints general symptoms skin

Critical manifestationens kidney CNS

2 Systemic sclerosis calcium deposits in the skin and other organs

3 DermatomyositisPolymyositis muscle weakness often curable

4 Sjoumlgrenlsquos syndrome Exocrine glands especially lacrimal and

salivary glands Most often occurs as secondary disease

ANA-IIF is mentioned but not mandatory often specific antiobodies are

mentioned Sm dsDNA RNP70 SS-A SS-B Scl-70 CENP RNA Pol III

77

CTD tests

Screening Single Tests

Symphony U1RNP (RNP70 A C)

Sm

SS-ARo (60 kDa 52 kDa)

SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79

AdvantagesDisadvantages of Different Methods

dsDNA Abs Method Sensitivity Specificity

CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA

Anti-dsDNA low avidity

Anti-dsDNA high avidity

not related to

any syndrome

related to SLE and

similar syndroms

related to SLE

Single stimulus Recurrentpersistent stimulation

somatic

mutations

time

Stimulation of

incompletely deleted

B-cells with inherent

specificity for dsDNA

conv

Elisa

Farr RIA EliA

Why this

Usage of graph kindly allowed by Prof OP Rekvig Tromso Norway

81



CLIFT

FARR RIA

ELISA

ELIA

82

Data from acuteinternalacute evaluation

SLE SLE Act Gr I SLE Act Gr II SLE Act Gr III01

1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83

Results out of this comprehensive analysis

activity Index (SLEDAI) Activity Group total neg pos pos in activity group

0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84

Detailed analysis - graph


1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85

The Importance of Specificity

Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000

Prevalence 2 Sens 74 spec 985 (EliA CCP) Bizzaro N et al 2007

147 false positives potentially referred on to specialists andor treatment PPV = 50

86


Test positive Test negative Total

RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000

Prevalence 2 Sens 73 spec 96 (Inova CCP3) Bizzaro N et al 2007

245 patients more with a false positive result PPV = 27

87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000

Prevalence 2 Sens 54 spec 86 (RF) Bizzaro N et al 2007


88

CCP is much more specific than RF

Disease n CCP n in RF n in

SLE 77 8 10 19 25

Sjoumlgrenlsquos syndrome 156 22 14 80 51

scleroderma 148 6 4 22 15

myosits 11 3 27 1 9

ankylosing spondylitis 43 6 14 4 9

psoriatic arthritis 34 2 6 3 9

non-classified arthritis 103 11 11 5 5

osteoarthritis 15 1 7 3 20

fibromyalgia 22 3 14 4 18

total 609 62 102 150 246

Fabien et al Clin Rev Allerg Immunol 2008 3440-44

89

1997 ACR Classification Criteria for Lupus

90

1 J Wenzel R Gerdsen M Uerlich R Bauer T Bieber and I Boehm ldquoAntibodies targeting extractable nuclear antigens historical development and current knowledgerdquo British Journal of Dermatology vol 145 no 6 pp 859ndash867 2001

2 Ryusuke Yoshimi Atsuhisa Ueda Keiko Ozato and Yoshiaki Ishigatsubo Clinical and Pathological Roles of RoSSA Autoantibody System Hindawi Publishing Corporation Clinical and Developmental Immunology Volume 2012 Article ID

606195 12 pages doi1011552012606195

3 van den Hoogen FHJ van de Putte LBA (1996) Anti-U1snRNP antibodies and clinical associations In vanVenrooij WJ Maini RN (eds) Manual of Biological Markers of Disease pp C31 1-8 Kluwer Academic Publishers Dordrecht

4 Reichlin M Scofield RH (1996) SS-A (Ro) autoantibodies In Peter JB Shoenfeld Y (eds) Autoantibodiespp 783-788 Elsevier Amsterdam

5 Keech CL McCluskey J Gordon TP (1996) SS-B (La) autoantibodies In Peter JB Shoenfeld Y (eds)Autoantibodies pp 789-797 Elsevier Amsterdam

6 Dugar M Cox S Limaye V et al (2010) Diagnostic utility of anti-Ro52 detection in systemic autoimmunity Postgrad Med J 86 79ndash82

7 Tan EM (1999) Autoantibodies in Diagnosis and in Identifying Autoantigens Immunologist 7 85-92

8 Peng SL Craft JE (1996) Spliceosomal snRNPs autoantibodies In Peter JB Shoenfeld Y (eds)Autoantibodies pp 774-782 Elsevier Amsterdam

9 Craft J Hardin J (1992) Anti-snRNP Antibodies In Wallace DJ Hahn BH (eds) Dubois Lupus Erythematosus pp 216-224 Williams and Wilkens

10 Maddison PJ (1996) Aminoacyl-tRNA Histidyl (Jo-1) Synthetase Autoantibodies In Peter JB Shoenfeld Y (eds) Autoantibodies pp 31-35 Elsevier Amsterdam

11 Kuwana M Kaburaki J Okano Y Tojo T Homma M Clinical and prognostic associations based on serum antinuclear antibodies in Japanese patients with systemic sclerosis Arthritis Rheum 19943775ndash83

12 Reveille JD Fischbach M McNearney T Friedman AW Arnett FC GENISOS Study Group Systemic sclerosis in 3 US ethnic groups a comparison of clinical sociodemographic serologic and immunogenetic determinants Semin Arthritis

Rheum 200130332ndash346 doi 101053sarh200120268

13 Ihn H Sato S Fujimoto M Kikuchi K Igarashi A Soma Y Tamaki K Takehara K Measurement of anticardiolipin antibodies by ELISA using β2-glycoprotein I (β2-GPI) in systemic sclerosis Clin Exp Immunol 1996105475ndash479

14 Sharp GC Irvin WS May CM Association of antibodies to ribonucleoprotein and Sm antigens with mixed connective-tissue disease systemic lupus erythematosus and other rheumatic diseases N Eng J Med 19762951149ndash1154

15 Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus Arthritis Rheum 40 1725

16 Gerli L Caponi L Anti-ribosomal P protein antibodies Autoimmunity 2005 3885-92

17 Linnik MD Hu JZ Heilbrunn KR et al (2005) Relationship between anti-double-stranded DNA antibodies and exacerbation of renal disease in patients with systemic lupus erythematosus Arthritis Rheum 52 1129-1137

18 Mahler M Miyachi K Peebles C Fritzler MJ The clinical significance of autoantibodies to the proliferating cell nuclear antigen (PCNA) Autoimmun Rev 2012 doi101016jautrev201202012

19 Nikpour M et al Prevalence correlates and clinical usefulness of antibodies to RNA Polymerase III in systemic sclerosis a cross-sectional analysis of data from an Australian cohort Arthritis Research amp Therapy 2011 13 R211

20 Conrad K Schoessler W Hiepe F Fibrillarin antibodies In Autoantibodies in systemic autoimmune diseases - A diagnostic reference Lengerich Pabst Science Publishers 78ndash79

21 Ho KT and Reveille JD (2003) The clinical relevance of autoantibodies in scleroderma Arthritis Res Ther 580-93

22 Walker JG and Fritzler MJ (2007) Update on autoantibodies in systemic sclerosis Curr Opin Rheumatol 19 580ndash591

23 Ghirardello A Zampieri S Tarricone E et al Cutting Edge Issues in Polymyositis Clin Rev Allergy Immunol 20101-11

91

New Consensus

A second PR3-MPO-ANCA or IIF

can be considered for negative

results in patients with a high clinical

suspicion

(to increase sensitivity) or in case of

low antibody levels (to increase

specificity) Take antibody level into

account

Source see previous page

92

bull Patients presenting with raised RF IgA developed more severe erosive disease

ndash They developed a greater number of erosions12

ndash These patients required much more pharmaceutical treatment1

bull The presence of RF IgA could justify more aggressive treatment at an early

stage1

but may predict a poor response to TNF inhibitors3

RF IgA has high prognostic value1

1 Teitsson I et al Ann Rheum Dis 1984 2 Eggelmeijer F et al Rheumatol Int 1900 3 Bobbio-Pallavicini F et al Ann Rheum Dis 2007

Further support from Tarkowski A and Nilsson L J Clin Lab Immunol 1983 Winska Willoch HW et al Scand J Rheumatol suppl 1988 Van Zeben D et al Ann Rheum

Dis 1987 Gioud-Paquet M et al Ann Rheum Dis 1987 Brik R et al Clin Exp Rheumatol 1990 Elkon KB et al Clin Exp Immunol 1981 Luacutepartviacuteksson BR et al Scand J

Rheumatol 1992 and Elson CJ et al Rheumatol Int 1985

93


bull Slides have very different qualities and

high lot-to-lot variation

bull classical c-ANCA pattern has a c-ANCA

pattern in both fixations formalin and

ethanol (mostly anti-PR3)

bull classical p-ANCA pattern is seen only on

ehtanol-fixed cells gives a c-ANCA

pattern on formalin (mostly anti-MPO)

bull most frequent atypical ANCA formalin

negative ethanol p-ANCA (seldom anti-

MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180

How do interprete test result Example 30 pre-test probability




Source Bossuyt X et al 2017 Rheumatology 56(9) 1533-41

IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180



bull Rapidly progressive glomerulonephritis


IUml

96

Clinical syndromes associated with ANCA

Anti-MPO Anti-PR3

Disease Literature 1) Literature 1)

GPA (Wegener) 5-60 40-95

MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited

vasculitis (eg NCGN)

50-70 25-30

bull PR3 antibodies are quite specific for GPA (Wegenerrsquos granulomatosis) but

may occur in other ANCA-associated vasculitides

bull MPO antibodies occur in all ANCA-associated vasculitides and in

vasculitis of the kidney but almost never in other diseases such as

infections non-ANCA-associated vasculitides or connective tissue

diseases

bull 1) Wiik AS Rheum Dis Clin N Am 201036479ndash489

2

Sweden

bull Uppsala ndash Allergy

bull Global headquarters

bull PHC (Pharmaceutical and Healthcare Collaborations)

bull Helsingborg ndash Allergy

bull Allergon ndash Allergen raw material

Germany

bull Freiburg ndash Autoimmunity

Immunodiagnostics division - centers of excellence

3






Celiac disease


Thyroid diseases


4


autoimmune diseases

5


6









bull Vaccination

bull Antibiotics

bull hellip



8


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


9




(PR3)



(MPO)




bull atypical ANCA




c-ANCA

staining the

whole

cytoplasm of

the

granulocytes

p-ANCA

staining only

the

surrounding

of the cell

nucleus

10


1990











11






needs revisionrdquo

12

New Consensus


13

New Consensus


14










15






16


antibody titer










EliA MPOs and EliA

PR3s

Positive

Likelihood

Ratio

Percentage of

vasculitis

patients in a

multicenter study

(n=1175)

0 - 21 IUml 01 10


50 ndash 160 IUml 12 18

160 ndash 1420 IUml 59 57


17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






nodules or both

IUml

30

1

60

90

100


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


3






Celiac disease


Thyroid diseases


4


autoimmune diseases

5


6









bull Vaccination

bull Antibiotics

bull hellip



8


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


9




(PR3)



(MPO)




bull atypical ANCA




c-ANCA

staining the

whole

cytoplasm of

the

granulocytes

p-ANCA

staining only

the

surrounding

of the cell

nucleus

10


1990











11






needs revisionrdquo

12

New Consensus


13

New Consensus


14










15






16


antibody titer










EliA MPOs and EliA

PR3s

Positive

Likelihood

Ratio

Percentage of

vasculitis

patients in a

multicenter study

(n=1175)

0 - 21 IUml 01 10


50 ndash 160 IUml 12 18

160 ndash 1420 IUml 59 57


17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






nodules or both

IUml

30

1

60

90

100


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


4


autoimmune diseases

5


6









bull Vaccination

bull Antibiotics

bull hellip



8


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


9




(PR3)



(MPO)




bull atypical ANCA




c-ANCA

staining the

whole

cytoplasm of

the

granulocytes

p-ANCA

staining only

the

surrounding

of the cell

nucleus

10


1990











11






needs revisionrdquo

12

New Consensus


13

New Consensus


14










15






16


antibody titer










EliA MPOs and EliA

PR3s

Positive

Likelihood

Ratio

Percentage of

vasculitis

patients in a

multicenter study

(n=1175)

0 - 21 IUml 01 10


50 ndash 160 IUml 12 18

160 ndash 1420 IUml 59 57


17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






nodules or both

IUml

30

1

60

90

100


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


5


6









bull Vaccination

bull Antibiotics

bull hellip



8


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


9




(PR3)



(MPO)




bull atypical ANCA




c-ANCA

staining the

whole

cytoplasm of

the

granulocytes

p-ANCA

staining only

the

surrounding

of the cell

nucleus

10


1990











11






needs revisionrdquo

12

New Consensus


13

New Consensus


14










15






16


antibody titer










EliA MPOs and EliA

PR3s

Positive

Likelihood

Ratio

Percentage of

vasculitis

patients in a

multicenter study

(n=1175)

0 - 21 IUml 01 10


50 ndash 160 IUml 12 18

160 ndash 1420 IUml 59 57


17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






nodules or both

IUml

30

1

60

90

100


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


6









bull Vaccination

bull Antibiotics

bull hellip



8


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


9




(PR3)



(MPO)




bull atypical ANCA




c-ANCA

staining the

whole

cytoplasm of

the

granulocytes

p-ANCA

staining only

the

surrounding

of the cell

nucleus

10


1990











11






needs revisionrdquo

12

New Consensus


13

New Consensus


14










15






16


antibody titer










EliA MPOs and EliA

PR3s

Positive

Likelihood

Ratio

Percentage of

vasculitis

patients in a

multicenter study

(n=1175)

0 - 21 IUml 01 10


50 ndash 160 IUml 12 18

160 ndash 1420 IUml 59 57


17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






nodules or both

IUml

30

1

60

90

100


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases




8


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


9




(PR3)



(MPO)




bull atypical ANCA




c-ANCA

staining the

whole

cytoplasm of

the

granulocytes

p-ANCA

staining only

the

surrounding

of the cell

nucleus

10


1990











11






needs revisionrdquo

12

New Consensus


13

New Consensus


14










15






16


antibody titer










EliA MPOs and EliA

PR3s

Positive

Likelihood

Ratio

Percentage of

vasculitis

patients in a

multicenter study

(n=1175)

0 - 21 IUml 01 10


50 ndash 160 IUml 12 18

160 ndash 1420 IUml 59 57


17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






nodules or both

IUml

30

1

60

90

100


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


8


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


9




(PR3)



(MPO)




bull atypical ANCA




c-ANCA

staining the

whole

cytoplasm of

the

granulocytes

p-ANCA

staining only

the

surrounding

of the cell

nucleus

10


1990











11






needs revisionrdquo

12

New Consensus


13

New Consensus


14










15






16


antibody titer










EliA MPOs and EliA

PR3s

Positive

Likelihood

Ratio

Percentage of

vasculitis

patients in a

multicenter study

(n=1175)

0 - 21 IUml 01 10


50 ndash 160 IUml 12 18

160 ndash 1420 IUml 59 57


17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






nodules or both

IUml

30

1

60

90

100


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


9




(PR3)



(MPO)




bull atypical ANCA




c-ANCA

staining the

whole

cytoplasm of

the

granulocytes

p-ANCA

staining only

the

surrounding

of the cell

nucleus

10


1990











11






needs revisionrdquo

12

New Consensus


13

New Consensus


14










15






16


antibody titer










EliA MPOs and EliA

PR3s

Positive

Likelihood

Ratio

Percentage of

vasculitis

patients in a

multicenter study

(n=1175)

0 - 21 IUml 01 10


50 ndash 160 IUml 12 18

160 ndash 1420 IUml 59 57


17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






nodules or both

IUml

30

1

60

90

100


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


10


1990











11






needs revisionrdquo

12

New Consensus


13

New Consensus


14










15






16


antibody titer










EliA MPOs and EliA

PR3s

Positive

Likelihood

Ratio

Percentage of

vasculitis

patients in a

multicenter study

(n=1175)

0 - 21 IUml 01 10


50 ndash 160 IUml 12 18

160 ndash 1420 IUml 59 57


17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






nodules or both

IUml

30

1

60

90

100


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


11






needs revisionrdquo

12

New Consensus


13

New Consensus


14










15






16


antibody titer










EliA MPOs and EliA

PR3s

Positive

Likelihood

Ratio

Percentage of

vasculitis

patients in a

multicenter study

(n=1175)

0 - 21 IUml 01 10


50 ndash 160 IUml 12 18

160 ndash 1420 IUml 59 57


17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






nodules or both

IUml

30

1

60

90

100


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


12

New Consensus


13

New Consensus


14










15






16


antibody titer










EliA MPOs and EliA

PR3s

Positive

Likelihood

Ratio

Percentage of

vasculitis

patients in a

multicenter study

(n=1175)

0 - 21 IUml 01 10


50 ndash 160 IUml 12 18

160 ndash 1420 IUml 59 57


17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






nodules or both

IUml

30

1

60

90

100


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


13

New Consensus


14










15






16


antibody titer










EliA MPOs and EliA

PR3s

Positive

Likelihood

Ratio

Percentage of

vasculitis

patients in a

multicenter study

(n=1175)

0 - 21 IUml 01 10


50 ndash 160 IUml 12 18

160 ndash 1420 IUml 59 57


17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






nodules or both

IUml

30

1

60

90

100


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


14










15






16


antibody titer










EliA MPOs and EliA

PR3s

Positive

Likelihood

Ratio

Percentage of

vasculitis

patients in a

multicenter study

(n=1175)

0 - 21 IUml 01 10


50 ndash 160 IUml 12 18

160 ndash 1420 IUml 59 57


17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






nodules or both

IUml

30

1

60

90

100


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


15






16


antibody titer










EliA MPOs and EliA

PR3s

Positive

Likelihood

Ratio

Percentage of

vasculitis

patients in a

multicenter study

(n=1175)

0 - 21 IUml 01 10


50 ndash 160 IUml 12 18

160 ndash 1420 IUml 59 57


17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






nodules or both

IUml

30

1

60

90

100


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


16


antibody titer










EliA MPOs and EliA

PR3s

Positive

Likelihood

Ratio

Percentage of

vasculitis

patients in a

multicenter study

(n=1175)

0 - 21 IUml 01 10


50 ndash 160 IUml 12 18

160 ndash 1420 IUml 59 57


17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






nodules or both

IUml

30

1

60

90

100


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


17

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






nodules or both

IUml

30

1

60

90

100


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


18

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases




20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


20


EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


21



Score

1 Joint involvement

1 large joint 0













lt6 weeks 0

6 weeks 1


protein antibody

(ACPA) (tested as

antindashcyclic


[anti-CCP])rdquo


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


22



0

10

20

30

40

50

60

70

80

0246810


CC

P-2

po

sit

ive


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


23


without treatment




time window of

opportunity for

early efficient

treatment opened

by CCP

Joint

damage and

functional

disability


Diagnosis

24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


24


Prevalence []




0-15


EliA RF IgM Well




Scleroderma 20-30





Tuberculosis 15





Publishers 2015

25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


25






bull






26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


26











- - - + Very likely

+ - - + Very likely

+ + - - Likely

+ - - - Possible


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


27








bull Oligoarthritis









28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


28


JIA




CCP in JIA

29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


29

Thank you



31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases




31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


31



EliA CCP IgG

EliA RF IgM

EliA RF IgA

EliA RF IgG

Vasculitis

EliA MPOS

EliA PR3S

EliA GBM

Anti-Phospholipid

Syndrome








EliA CTD Screen

EliA SymphonyS

EliA dsDNA

EliA U1RNP

EliA RNP70

EliA SmDP

EliA Ro

EliA Ro52

EliA Ro60

EliA La

EliA Scl 70

EliA Jo-1

EliA CENP

EliA Rib-P

EliA PCNA

EliA PM-Scl

EliA Fibrillarin

EliA Mi-2

EliA ssDNA

EliA RNA Pol III

Celiac Disease

EliA Gliadin IgA

EliA Gliadin IgG

EliA GliadinDP IgA

EliA GliadinDP IgG

EliA Celikey IgA

EliA Celikey IgG

IBD

EliA Calprotectin2

EliA ASCA IgG

EliA ASCA IgA

Miscellaneous

EliA Anti-IgA


EliA Parietal Cells

Thyroid

EliA anti-TG

EliA anti-TPO

EliA anti-TSH-R

32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


32

autoimmune





(SLE)

3 - 400 100000 51 100000



(DMPM)

15 1000000 60 1000000


(MCTD)

50 100000 20 1000000





33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


33




bull fever


bull weakness









34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


34

Fatigue

Hair fall

Oral Ulcer

Arthralgia


Fevers

And many many more



35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


35

SLE


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


36









Ro Ab4

Neonatal lupus





37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


37

SLE


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


38











39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


39


A homogeneous

B quasihomogeneous

C fine speckled

D coarse speckled



40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


40



41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


41












bull Cancer


bull Lung diseases

bull Skin diseases

bull Infections






42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


42

What is the effect






lt05 or 15 million



43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


43




ANA-IIF (120)

Sensitivity 89

Specificity 77

EliA CTD Screen

Sensitivity 74

Specificity 95




44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


44





test POS test NEG

CTD 74 26

none-CTD 45 855

119 881


test POS test NEG

CTD 89 11

none-CTD 207 693

296 704



45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


45










46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


46













47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


47



systemic sclerosis


Antibodies 45 76 26 7 19 9 6 2

EliA CTD

Screenpositive

43 75 26 7 18 9 6 2

EliA CTD

Screenborderline

2 0 1 0 0 0 0 0

ANA-IIFpositive

1160

33 65 25 5 19 7 6 0




symptoms

48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


48


Sjӧgrenrsquos

syndrome

Systemic lupus

erythematosus


tis

Mixed connective

tissue disease

Ro52 kDa 70-

10012

dsDNA 90

(active)15


Ro60 kDa 70-

10012



systemic19

Ro60 kDa 156

U1RNP 30-4078 Ro52 kDa 206 Mi-2 10-1523

SmD 20-3078 U1RNP (AC70) 8-1411-14 Pm-Scl 82122

Rib-P 15-2016 Ro60 kDa 66




Pm-Scl 242122

Mo

re c

om

mo

n gt

lt More common


lt L

ess c

om

mo

n

Less common gt

49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


49

Summary







world8









50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


50

Thank you

51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


51




Basedow

Celiac Disease




Myasthenia Gravis



Vasculitis


MCTD

Scleroderma



52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


52

Conclusion







52


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


53

54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


54





CTDs



54


the doctors

55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


55





Positive n

()

Sensitivity

()

Positive n

()

Sensitivity

()

SLE 28 28 (100) 100 21 (75) 80

SS 17 16 (94) 94 17 (100) 100

SSc limited 9 9 (100) 100 8 (889) 90

SSc 2 2 (100) 100 2 (100) 100

MCTD 4 4 (100) 100 4 (100) 100




56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


56









57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


57

Criteria of SLE


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


58


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


59


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


60




change




61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


61

Scleroderma








minor criteria

62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


62



bull Honeycomb lung


pigmentation



63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


63






bull Puffy fingers



64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


64

First symptoms

Fatique



Further course




surface)


Scleroderma

65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


65

Scleroderma

66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


66



muscle and skin


Age every age




67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


67


First symptoms

Fatique


Further course

Symmetric pain


Pain in joints


Prognosis


immunosuppression

68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


68





Normal)















Lancet 2003 Sep 20362(9388)971-82

69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


69





xerostomia


Age 30-40 Years



70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


70


First symptoms

Fatique

Dry eyes


are



Intense caries




of SLE (1-3)

71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


71


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


72






73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


73







Age every age



74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


74

MCTD

First symptoms

Fatique


Muscle weakness


Further course



75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


75

MCTD - criteria

76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


76

Summary










77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


77

CTD tests



Sm


SS-BLa

Centromere B

Scl-70

Jo-1

dsDNA

Fibrillarin

RNA Pol III

Rib-P

PM-Scl

PCNA

CTD Screen Mi-2

78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


78

79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


79



CLIFT

FARR RIA

ELISA

80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


80

Anti-ssDNA

Anti-ssDNA



not related to

any syndrome

related to SLE and

similar syndroms

related to SLE


somatic

mutations

time

Stimulation of




conv

Elisa

Farr RIA EliA

Why this


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


81



CLIFT

FARR RIA

ELISA

ELIA

82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


82



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


83



0 I 2 2 0

2 I 28 19 9

3 I 1 1 0

4 II 3 0 3

6 II 11 2 9

8 II 1 0 1

10 II 5 1 4

12 III 4 0 4

14 III 5 0 5

23 III 1 0 1

32 III 3 0 3

Total 64 25 39 609

290

850

1000

84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


84



1

10

100

1000

=

Eli

A d

sD

NA

in

IU

ml

85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


85


Test positive Test

negative

Total

RA 148 52 200

Non-RA 147 9653 9800

Total 295 9705 10000



86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


86



RA 146 54 200

Non-RA 392 9408 9800

Total 538 9558

10000



87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


87



RA 108 92 200

Non-RA 1372 8428 9800

Total 1480 8520 10000



88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


88



SLE 77 8 10 19 25



myosits 11 3 27 1 9






total 609 62 102 150 246


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


89


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


90



606195 12 pages doi1011552012606195























91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


91

New Consensus




suspicion




account


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


92





stage1







93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


93












MPO)

c-ANCA

p-ANCA

in

ethanol-

fixed

granulo-

cytes

94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


94

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180






IUml

95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


95

0

02

04

06

08

1

0 02 04 06 08 1

Po

st-

test p

rob

ab

ility


EliA

0 - 21 21 - 5 5 - 16 16 - 142 142 - 180





IUml

96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


96


Anti-MPO Anti-PR3



MPA 50- 70 25-30

EGPA

(Churg-Strauszlig)

30-40 9-30

Renal limited


50-70 25-30






diseases


Documents

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