THE STUDY

1. When one is doing multiple comparisons and thus calculating p values, one needs to correct for type I error (that the differences could have been due to chance) by using a Bonferroni or equivalent correction, such as multiplying all the p values by the number of comparisons in which p values were shown to get a corrected p value--your tables show 26 p values--thus if you multiply all your p values by 26, the only noncorrected p values that will remain "significant" is a uncorrected p of <0.001

2. Some critical references omitted

RESULTS & CONCLUSIONS

There are a number of papers etc omitted as follows:

1. No correlation with ANA titer and clinical activity (DH Solomon et al Arth Rheum 2002; 47:434-44

2. Specific solid phase immunoassays have largely replaced immunodiffusion tests and looking at patterns: L Cook Clin Inmmunol Immunopath 1998; 88:211-20

3. Homogeneous=diffuse pattern best recognizes the DNA-histone complex (nucleosome) (and this Ab responsible for the LE cell phenomenon)

4. The peripheral (also called rim) pattern is due to anti-dsDNA, and is not seen well on Hep-2 cells, but is well seen on mouse/rat liver sections

5. The Danish group have described about 20 speckled patterns-- major Ab associated with speckled include anti-Sm, RNP, Ro/SSA, La/SSB, Scl-70, centromere, PCNA

6. M Reichlin et al described Ro and La in SLE patients, and a few years later E Tan described SSA and SSB in patients with Sjogren's- -years later they were convinced to exchange reagents, and lo and behold Ro=SSA and La=SSB--so no now we routinely say Ro/SSA and La/SSB

7. For a ACR sponsored review of the significance of anti-Sm and anti-RNP by immunodiffusion and ELISA (EIA) see: Arth & Rheum 2004; 51:1030-44--which gives better data than cited by the authoirs

8. For the ACR sponsored review of anti-DNA see ARTH RHEUM 2002; 47:546-555

9. Solid phase assays (ELISA, EIA) have virtually replaced immunodiffusion for detection of anti-DNA, ENA etc, in virtually all labs in the USA--more sensitive , easier to do, better QC, automated (see above #7 and #8 )

10. Jill Buyon has written more recent ref that you cited#28

11. For publication purposes we usually only include SLE patients who have 4 or more ACR criteria--having less just means they might have SLE (according to the ACR Classification criteria)

12. ANA patterns may vary over time and at different dilutions

13. Most USA labs use a titer of 1:40 as a cut off--SLE patients who were positive at 1:200 (or greater) who turn negative, may thus in the USA still be positive if they have a titer betyween 1:40 and 1:200

14. Under results you mention "immunologic disorder"--please define

15. Results: the frequency of renal disease and anti-DNA in your cohort is lower than most other published chorts--why--is there something unique about your group of patients--usually renal is at least 50%, and anti-DNA about 75%

16. Discussion: Friou not Holman and Kunkel described the IF ANA in SLE : with different cell substrates (liver, kidney, Hep-2, other cell lines) see different patterns

17. No association of photosensitivity with Ro:

18. Paz ML, Gonzalez Maglio DH, Pino M, Ferrari A, Weill FS, Nasswetter G. Leoni J. Anti-ribonucleoprotein autoantibodies in patients with systemic autoimmune diseases. Relation with cutaneous photosensitivity. Clinical Rheumatology 2011; 30:209-16.

19. Boey ML, Peebles CL, Tsay G, et al. Clinical and autoantibody correlations in Orientals with systemic lupus erythematosus. Ann Rheum Dis 1988; 47:918-23.

20. Wang CL, OOI L, Wang F: Prevalence and clinical significance of antibodies to ribonucleoproteins in systemic lupus erythematosus in Malaysia. Br Soc Rheumatol 1996, 35:2; 129-32

21. Mok CC, Lau CS, Chan TM, Wong RWS: Clinical characteristics and outcome of southern Chinese males with systemic lupus erythematosus. Lupus 1999,8: 188-96.

22. Christian N, Smikle MF, DeCeulaer K, Daniels L, Walravens MJ, Barton EN. Antinuclear antibodies and HLA class II alleles in Jamaican patients with systemic lupus erythematosus. West Indian Med J 2007; 56: 130-3.