Serum antinuclear and extractable nuclear antigen antibody prevalence and associated morbidity and mortality in the general population over 15years

Carlo Selmi, Angela Ceribelli, Elena Generali, Carlo A. Scirè, Fausto Alborghetti, Guido Colloredo, Luisa Porrati, Maria I S Achenza, Maria De Santis, Francesca Cavaciocchi, Marco Massarotti, Natasa Isailovic, Valentina Paleari, Pietro Invernizzi, Torsten Matthias, Alberto Zucchi, Pier Luigi Meroni

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29 Scopus citations


The prevalence of ANA and anti-ENA in the general population is not well established, especially their clinical significance in healthy subjects. We herein determined the prevalence and predictive value of serum ANA and anti-ENA for connective tissue diseases (CTD), cancer, and mortality. We took advantage of a randomly selected sample of the 1998 general population (Isola I) consisting of 2828 subjects (53% women, age 43 ± 13 years) from a well-defined Northern Italian area. Serum ANA and anti-ENA were tested on the 2690 samples available in 2012 (Isola II, 50% women, age 58 ± 13 years). Administrative databases were searched for CTD, cancer diagnosis, and death cases occurring between enrollment and December 31, 2013. The hazard ratio (HR) was calculated for incident cases. Serum ANA is positive in 18.1% for any titer and 6.1% for titers ≥ 1:160, 23% in subjects over 50 years and 13.1% and 6.1% for any titer and titers ≥ 1:160, respectively, in women. The HR for CTD development was significantly high for all ANA titers, with the highest for ANA ≥ 1:160 (HR 14.19, 95% CI 3.07-65.68). ANA positivity was not associated with cancer (HR 1.03; 95% CI 0.75-1.43), or with mortality (HR adjusted for age and sex 1.40; 95% CI 0.94-2.09). Serum anti-ENA is positive in a minority of subjects with highest figures for anti-nucleosome (1.9%), -histone (1.6%) and -PM/Scl (1.5%). In conclusion, serum ANA prevalence in the general population is highest in senior subjects and in women, while the female predominance is significantly lower compared to overt CTD. Serum ANA is associated with an increased probability of CTD development over time, but does not influence survival or cancer risk.

Original languageEnglish (US)
Pages (from-to)162-166
Number of pages5
JournalAutoimmunity Reviews
Issue number2
StatePublished - Feb 1 2016
Externally publishedYes



  • Age
  • Autoimmunity
  • Cancer
  • Clinical epidemiology
  • Connective tissue disease
  • Gender
  • Survival

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy

Cite this

Selmi, C., Ceribelli, A., Generali, E., Scirè, C. A., Alborghetti, F., Colloredo, G., Porrati, L., Achenza, M. I. S., De Santis, M., Cavaciocchi, F., Massarotti, M., Isailovic, N., Paleari, V., Invernizzi, P., Matthias, T., Zucchi, A., & Meroni, P. L. (2016). Serum antinuclear and extractable nuclear antigen antibody prevalence and associated morbidity and mortality in the general population over 15years. Autoimmunity Reviews, 15(2), 162-166.