Objective This study aimed to establish a screening model for differentiating anti-synthetase syndrome (ASS) from other antinuclear antibody (ANA)-associated rheumatic diseases (AARD) using a combination of cytoplasmic and non-cytoplasmic ANA (ncANA) patterns. Methods This retrospective observational study included patients with AARDs such as systemic lupus erythematosus (SLE), systemic sclerosis (SSc), Sjögren's syndrome (SS), mixed connective tissue disease (MCTD), and polymyositis/dermatomyositis (PM/DM) who underwent ANA screening between April 2012 and December 2021. Variables included age, sex, ANA patterns (Cytoplasmic and ncANA), and titers. Logistic regression analysis of Cytoplasmic and ncANA patterns was performed to differentiate ASS from other AARDs. Result The 981 diagnosed cases of AARDs consisted of SS (n = 451), SSc (n = 264), SLE (n = 201), PM/DM (n = 104), MCTD (n = 52), and ASS, including PM/DM (n = 64). Of these, 155 patients had ≥2 overlapping diseases; however, there was no overlap between AARDs and ASS. ASS is more likely to occur when the cytoplasmic titer is positive and the ncANA <320. Receiver operating characteristic (ROC) analysis of the Cytoplasmic and ncANA range revealed an area under the ROC curve (AUC) of 0.885 (95% CI: 0.844 to 0.927). Conclusion It is important to detect cytoplasmic patterns as an ANA screening test for ASS diagnosis, even if the titer is low. Additionally, combining the cytoplasmic and ncANA patterns yields more accurate ASS screening results.

中文翻译：

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Hep-2 抗核抗体的细胞质和细胞核模式组合可用作抗合成酶综合征的筛查试验

目的 本研究旨在结合细胞质和非细胞质 ANA (ncANA) 模式建立筛查模型，以区分抗合成酶综合征 (ASS) 与其他抗核抗体 (ANA) 相关风湿病 (AARD)。方法 这项回顾性观察研究纳入了接受 ANA 治疗的 AARD 患者，例如系统性红斑狼疮 (SLE)、系统性硬化症 (SSc)、干燥综合征 (SS)、混合结缔组织病 (MCTD) 和多发性肌炎/皮肌炎 (PM/DM) 2012 年 4 月至 2021 年 12 月期间进行筛查。变量包括年龄、性别、ANA 模式（细胞质和 ncANA）和滴度。对细胞质和 ncANA 模式进行逻辑回归分析，以区分 ASS 与其他 AARD。结果 981 例 AARD 诊断病例包括 SS（n = 451）、SSc（n = 264）、SLE（n = 201）、PM/DM（n = 104）、MCTD（n = 52）和 ASS，包括PM/DM (n = 64)。其中，155名患者患有≥2种重叠疾病；然而，AARD 和 ASS 之间没有重叠。当细胞质滴度为阳性且ncANA＜320时更可能发生ASS。细胞质和 ncANA 范围的受试者工作特征 (ROC) 分析显示 ROC 曲线下面积 (AUC) 为 0.885（95% CI：0.844 至 0.927）。结论 作为 ASS 诊断的 ANA 筛查试验，检测细胞质模式很重要，即使效价较低。此外，结合细胞质和 ncANA 模式可产生更准确的 ASS 筛选结果。