DESCRIPTION OF ANTINUCLEAR ANTIBODY PROFILE IN

CHILDREN SYSTEMIC LUPUS ERYHTEMATOSUS PATIENTS AT

HASAN SADIKIN HOSPITAL BANDUNG

Raden Reni Ghrahani Dewi Majangsari, Adhi Kristianto Sugianli, Michael Putra
Nugroho

S
ystemic Lupus Erythematosus is a
chronic autoimmune disease that
Abstract affects many organs in the body.
Background Systemic Lupus Erythematosus is a rare
life threatening multisystemic disease with various This disease has varying symptoms from
manifestations. This disease and its manifestations and
severity can be confirmed by using anti-nuclear antibody mucosal manifestations such as mouth
profiles.
Objective To find out the description of ANA profile ulcers to central nervous system
test in childhood systemic lupus erythematosus patients at
Hasan Sadikin Hospital, Bandung
manifestations such as epilepsy. Several
Methods This cross-sectional study was conducted at factors such as immunologic factors,
Hasan Sadikin Hospital, Bandung, by examining the
medical records of Hospitalized childhood SLE patients genetics, age, race, gender, and
(0-<18 years old.) The inclusion criterias were Childhood
SLE patients who met the ACR 1997 OR SLICC 2012 environmental factors, may contribute to
OR EULAR 2019 and have been tested for ANA profile.
We analysed the patients’ age, gender, clinical the development of SLE1
manifestations and ANA profiles.
Results Anti-nRNP/Sm and Anti-Nucleosome (9) were The prevalence of SLE varies in
tied as the most found ANA profile. The second most
found ANA profiles were Anti-Sm and Anti-SSA (6) different nations. A research that was
They are followed by Anti-Rib P and Anti-Histone (5).
The fourth most found ANA profile was Anti-Ro52 (4), conducted in 2017 showed that in the Asia-
the fifth was Anti-DFS70 (2), and the sixth were Anti-
AMA-M2, Anti-SCL-70, and Anti-PM-Scl100 (1). Pacific region the incidence rate of this
Conclusion Most Childhood SLE patients that
underwent ANA profile test were presented with Anti- disease was 0,9-3,1/100.000 population per
RNP/Sm .
Keywords: Systemic Lupus Erythematosus; Children; ANA Profile year.2 In Indonesia, a research that was
conducted by the Indonesian Ministry of
Health in 2009 showed that childhood SLE

From the Department of Child Health, Universitas

Padjadjaran/Hasan Sadikin Hospital Bandung

Corresponding author: Reni Ghrahani, Jalan Rancakendal

no. 172, Bandung, Indonesia, 40191. Email:
reni.ghrahani@unpad.ac.id

affected 10-20 /100.000 children. Apart

from that, data acquired from Indonesian
Hospital Information System shows us that
the number of patients that were expertise of the clinician that is
hospitalized increased two folds from 2014 overseeing.6
to 2016.3
Methods
Childhood SLE is a type of SLE that
starts or shows symptoms before the age This cross-sectional study was conducted

of 18 years old, with a prevalence rate of at Hasan Sadikin Hospital, Bandung. We

3,3-8,8/100.000 children and incidence rate examined the medical records of childhood

of 0,3-0,9/100.000 per year.4 Childhood SLE patients (0-<18 years old) who have

SLE is also more severe and is associated been tested for ANA profile by using the

with more diverse manifestations than the Western Blot method from 2019 to 2022.

one that affects the adult.5 The inclusion criterias were

Antinuclear antibody test is one of the hospitalized childhood SLE patients who

laboratory examinations that is widely met the ACR 1997 OR SLICC 2012 OR

accepted to diagnose SLE. Antinuclear EULAR 2019 criterias and have been

antibody is an autoantibody that attacks tested for ANA profile. The exclusion

components inside the cell such as criteria was patients whose medical records

proteins, DNA, and RNA. This tells us that were incomplete.

a positive ANA result may indicate that the The subjects of this research

patient potentially has an autoimmune underwent the western blot method which

disease, such as SLE.6 One of the looks for 16 ANA profiles. The ANA

supporting tests to ANA test is Western profiles that were used in this research

Blot which tests ANA profile. One of the were as follows: Anti-nRNP/sm, Anti-Sm,

typical components of the Western Blot Anti-SSA, Anti-Ro52, Anti-SSB, Anti-

test is anti-dsDNA, is found in 75% of SCL-70, Anti-PM-Scl100, Anti-Jo1, Anti-

childhood SLE patients. Consequently, CENPB, Anti-PCNA, Anti-dsDNA, Anti-

Anti-dsDNA and the clinical Nucleosome, Anti Histones, Anti-Rib P,

manifestations of the patients would be Anti-AMA-M2, and Anti DFS70.

examined when diagnosing the patient and The sample that we could analyze are

should be tested throughout the time of presented at Figure 1. We found that there

illness.7 are 198 hospitalized children (0-18 years

SLE does not have a consistent old) that was diagnosed with SLE at Hasan

clinical manifestation. Hence the final Sadikin Hospital, Bandung from 1st of

diagnosis of the patient is dependent on the

Figure 1. flowchart of chosen samples
January 2019 to 31st of December 2022, 40
of which has met the ACR 1997 OR
SLICC 2012 OR EULAR 2019 criterias
and underwent ANA profile test. Out of
the 40, only 24 of which have medical
records that could be accessed and 16 of
them were excluded because of incomplete
data.
The sample of this research were
chosen using total sampling. Acquired
medical records were analyzed using SPSS
ver. 23.0 software. We used descriptive
analysis for patients’ characteristics, clinical
manifestations and ANA profiles. The
characteristics of the patients and ANA
profiles per clinical manifestations were
shown as number (n). Results of the
research will be shown and interpreted
using table and narration.
Results
Our research found that out of 24 patients
that was diagnosed with childhood SLE
most of them were female. We used AAP
(American Academy of Pediatrics) age
ranges to categorize the samples into
infant, childhood and adolescence.8 We
found that there were no infant patients, 5
of them were childhood age, and 19 of
them had reached adolescence. Our
complete characteristic of the samples that
we took are presented in table 1.
Our study found that skin and mucous
manifestations appeared most prominently
in our population, reaching 23 samples. It
is followed by hematologic manifestations
that was found in 19 samples and renal
manifestations which reached 15 samples.
Table 1. Subject’s Characteristics which said that the results could be
Clinical Characteristic (N=24) attributed to the effects of estrogen,
Gender (n) decreased androgen levels, and differences
Male 2 in GnRH signalling.
Female 22 This study shows that the ANA profile

Age (n) that most frequently showed up was Anti-

0-2 0 nRNP and Anti-Nucleosome, both was

2-12 5
found in 9 patients. This findings differed

12-18 19
from the study conducted by Ahmed et al.10
in which the most prominent ANA profiles
Our study also discovered that the that were found were Anti-dsDNA and
most predominantly found ANA profile Anti-Ro-52. This difference could be
was Anti- nRNP/Sm and Anti- caused by different geographical, racial
Nucleosome, both was found in 9 patients. and age variations.
Both of those ANA profiles were most
frequently found with skin and mucous Our study found that skin and mucous

manifestations. Complete clinical manifestations appeared most prominently

manifestation and ANA profile are in our population reaching 23 samples. The

presented in table 2. ANA profile that showed up most

Discussion
Systemic Lupus Eryhtemathosus is a multi-
systemic disease with varying population
characteristic factors such as gender, age,
and race. Our study found that SLE is
predominantly found in patients aged 12-
18, which match up to a research that was
conducted by silverman.9 From table 1 we
found that SLE mainly affects the female
populace. In which, the ratio of the female
to male population is 11:1, which is similar
to a research that was conducted in sudan
and italy.10 This pattern matched up with
the research conducted by Wasef et al. 11
frequently with this manifestation was
Anti-nRNPsm and Anti-Nucleosome. The
skin and mucous manifestations found in
the sample consisted of malar rash, discoid
rash, oedema, etc. This differs with the
results from Ghrahani et al. in which the
research shows hematologic involvement was
the most frequent manifestation that
appeared.12 This difference could be
attributed to different diagnostic methods
in which the previous research used ANA
Immunofluorescnce that resulted in more
diagnosed patients. In contrast, the patients
who tested for ANA
 Table 2. Subjects' Manifestations and ANA Profile
ANA Profile (n)

Anti-Nucleosome
Anti-nRNPsm

Anti-Ama M2
Anti-CENP B

Anti-Histone
Anti-dsDNA

Anti-PM‐Scl

Anti-DFS70
Anti-PCNA
Anti-Scl‐70
Anti-Ro‐52

Ant-Rib.p
Anti-SSA

Anti-SSB

Anti Jo‐1
Characteristics Anti- Sm
(9)

(6)

(6)

(4)

(0)

(1)

(5)

(1)

(0)

(0)

(0)

(9)

(5)

(5)

(1)

(2)
(N=24)

Manifestations
Skin and mucous
9 6 6 4 0 1 5 1 0 0 0 9 5 4 1 1
(23)
Musculokeletal
2 2 2 2 0 0 2 1 0 0 0 4 2 2 0 0
(13)
Renal 4
5 3 2 0 0 5 1 0 0 0 8 3 5 0 2
(15)
Neuropsychiatry
5 4 3 1 0 0 4 0 0 0 0 5 1 4 0 2
(9)
Gastrointestinal
5 4 4 2 0 0 3 1 0 0 0 4 3 4 0 2
(12)
Hematologic
8 5 6 4 0 0 3 1 0 0 0 6 5 4 1 2
(19)
Lung
6 5 4 3 0 0 2 0 0 0 0 4 3 1 0 1
(10)
Cardiovascular
4 3 2 0 0 1 2 0 0 0 0 3 1 2 0 1
(5)
profile using Western Blot is fewer in
comparison because the method
expensive and not covered by the National
Healthcare Insurance.
One of the limitations of this research
was its cross-sectional design, in which we
could describe the association between the
clinical manifestations of the sle patients to
the ANA profile that was found. But, at the
same time we couldn’t explain the
interaction between the 2 variables. In
addition, 16 of the 40 data that was
originally planned to be used were
incomplete. As a consequence, the data
that was analyzed is relatively small
compared to the previous researches.
Future research should look into the
interaction between the ANA profile and
clinical manifestations in order to help
predict the clinical patterns and diagnosis
of the patients. They should also take more
samples into account in order to further
understand the epidemiology of
disease.
Conflict of Interest
None declared.
Funding Acknowledgements
The researchers received no specific grants from any
funding agency in the public, commercial, or not-for-
profit sectors.
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