ANTINUCLEAR ANTIBODIES IN CHILDREN WITH CHRONIC NONSPECIFIC COMPLAINTS

Children who are chronically complaining nonspecific symptoms such as headache, fatigue, abdominal pain, and low grade fever are commonly se en in daily pediatric outpatient clinics. Some of them are unable to g o to school and are diagnosed as school refusal by physicians or educa tional staff. On the other hand, there are children who do not fulfill any criteria of collagen diseases and whose anti-nuclear antibodies ( ANA) are found to be positive. Some of these children have chronic non specific complaints. We prospectively studied the prevalence of ANA in children who visited a pediatric outpatient clinic because of chronic nonspecific complaints. Surprisingly, 74 out of 140 symptomatic child ren (52.4%) were positive for ANA, while only 5 out of 82 healthy cont rol children (6.1%) were positive (p < 0.0001). 39 of 74 ANA positive patients (52.1%) have low ANA titers less than or equal to 1:80, never theless 36 patients (47.9%) have high ANA titers greater than or equal to 1:160. ANA fluorescent patterns were homogeneous and speckled in 7 5.3%, speckled in 17.6% and others in 6.8%. ANA positive patients tend ed to have general fatigue and low grade fever, while gastrointestinal problems such as abdominal pain and diarrhea and orthostatic dysregul ation symptoms were commonly seen in ANA negative patients. Children w ho were unable to go to school more than 1 day a week were seen signif icantly more in ANA positive patients than in negative patients. Autoa ntibody analysis using Western immunoblot revealed that 26 out of 63 A NA positive sera (41.3%) had antibodies to the 62 kD protein which had not been previously noticed. These data suggest that autoimmune mecha nism may play a role in childhood chronic nonspecific symptoms. We the refore propose a new disease entity of the autoimmune fatigue syndrome in children. When chronically complaining children visit a pediatric out-patient clinic, immunological approaches should be considered befo re they are discriminated as school refusal or having psychogenic diso rders.