ANTINUCLEAR ANTIBODIES AND PATTERNS OF NUCLEAR IMMUNOFLUORESCENCE IN TYPE-1 AUTOIMMUNE HEPATITIS

To determine the significance of antinuclear antibodies and their patt erns of indirect immunofluorescence in type 1 autoimmune hepatitis, se ra from 99 patients were evaluated. Patients with antinuclear antibodi es had a lower frequency of liver transplantation (6% vs 22%, P = 0.04 ) than seronegative patients. They were also more commonly HLA-DR4-pos itive than seronegative patients (56% vs 30%, P = 0.05) and normal sub jects (56% vs 30%, P = 0.004). The 42 patients with antinuclear antibo dies and a diffuse pattern of indirect immunofluorescence had higher s erum titers of ANA (serum titers greater than or equal to 1:500, 71% v s 14%, P < 0.0001) and SMA (serum titers greater than or equal to 1:50 0, 69% vs 27%, P = 0.003) than the 22 patients with antinuclear antibo dies and a speckled pattern. These patients, however, were otherwise n ot distinguished by clinical features and treatment response. Patients with a speckled pattern had A1-B8-DR3 more frequently than patients w ith a diffuse pattern (65% vs 23%, P = 0.005) and normal subjects (65% vs 13%, P < 0.0001), but they had no other salient features. We concl ude that patients with antinuclear antibodies have a better long-term prognosis than seronegative patients, and they have HLA-DR4 more commo nly. The patterns of indirect immunofluorescence associated with ANA p ositivity have no practical clinical implications.