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. 2013 Oct;149(10):1159-65.
doi: 10.1001/jamadermatol.2013.4207.

Morphea in adults and children cohort III: nested case-control study--the clinical significance of autoantibodies in morphea

Jennifer Warner Dharamsi  1 , Sandra Victor, Nancy Aguwa, Chul Ahn, Frank Arnett, Maureen D Mayes, Heidi Jacobe
Affiliations

Morphea in adults and children cohort III: nested case-control study--the clinical significance of autoantibodies in morphea

Jennifer Warner Dharamsi et al. JAMA Dermatol. 2013 Oct.

Abstract

Importance: Small studies have implicated the association of specific autoantibodies with morphea subtype or severity, but no large-scale studies have been conducted. This prospective case-control study confirmed the presence of antinuclear antibodies (ANAs) and other autoantibodies in morphea but found they are of limited significance.

Objective: To determine the prevalence of ANAs, extractable nuclear antigens such as antihistone antibodies (AHAs), and anti-single-stranded DNA antibodies (ssDNA abs) in patients with morphea vs a healthy control population and their association with clinical measures of morphea severity.

Design, setting, and participants: Nested case-control study, conducted at the University of Texas Southwestern Medical Center, Dallas, and University of Texas Health Science Center, Houston. Study participants included individuals enrolled in the Morphea in Adults and Children (MAC) cohort and Scleroderma Family Registry and DNA Repository.

Main outcomes and measures: Prevalence of ANAs, AHAs, ssDNA abs in patients with morphea vs matched controls and association of the presence of autoantibodies with clinical indicators of morphea severity.

Results: The prevalence of ANAs, AHAs, and ssDNA abs in patients with morphea was 34%, 12%, and 8%, respectively. Antinuclear antibodies and AHAs, but not ssDNA abs, were present more frequently in cases than in controls. There was no difference in ANA prevalence among morphea subtypes. Among patients with linear morphea, the presence of autoantibodies was associated with clinical indicators of severe morphea including functional limitation (ssDNA ab, P = .005; and AHA, P = .006), extensive body surface area involvement (ssDNA ab, P = .01; and ANA, P = .005), and higher skin scores (ANA, P = .004). The presence of autoantibodies was not associated with clinical measures of morphea activity.

Conclusions and relevance: Our results demonstrate that ANAs and AHAs are more prevalent among patients with morphea but are of limited clinical utility except in linear morphea, where their presence, although infrequent, is associated with greater lesion burden and functional impairment.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1
Figure 1. Algorithm Summarizing Patients Included in the Present Study
MAC indicates Morphea in Adults and Children
Figure 2
Figure 2. Serum Samples That Had Antinuclear Antibodies (ANAs) Present at a Cutoff Titer of 1:80 Were Serially Diluted up to a Titer of 1:1280
The frequency (number of patients) of a positive ANA at each dilution and pattern of immunofluorescence on Hep-2 cells are presented. aData are given as number of patients
See this image and copyright information in PMC

Comment in

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